Jani Takatalo

Prevalence of degenerative imaging findings in lumbar magnetic resonance imaging among young adults.

Study Design. A cross-sectional imaging study of young adults. Objective. To investigate the prevalence of disc degeneration (DD) and displacement, anular tears, and Modic changes in lumbar magnetic resonance imaging (MRI) among young adults. Summary of Background Data. Although low back pain in young adulthood is common, the prevalence of spinal MRI findings at this age remains virtually unknown. Methods. The study population was a subcohort of the Northern Finland Birth Cohort 1986. Subjects living within 100 km of Oulu (n = 874) were invited to participate in lumbar MRI at 20 to 22 years of age (mean: 21.2 years). Degree of DD, type of Modic changes, and presence of disc bulges, herniations, high intensity zone (HIZ) lesions, and radial tears at all lumbar levels were assessed. Results. Three hundred twenty-five women and 233 men (n = 558) attended the MR imaging. DD was significantly more frequent in men (54% vs. 42%, P = 0.005), as was multiple DD (21% vs. 14%, P = 0.036). The prevalences of disc bulges and radial tears were 25% and 9.1%, respectively, without gender differences. HIZ lesions were more common among women than men (8.6% vs. 4.3%, P = 0.046), whereas herniations were significantly more common among men (5.6% vs. 2.5%, P = 0.047). Only 2 disc extrusions were observed, one in each gender. All degenerative disc findings were more common at the L5–S1 level except HIZ lesions, which were most likely at L4–L5. The prevalence of the Modic changes was 1.4%, without gender difference, type I being more common than type II. Typically, Modic changes were located adjacent to a DD Grade 4 disc and at the 2 lowest levels. Conclusion. Almost half of young Finnish adult aged 21 years had at least one degenerated disc, and a quarter had a bulging disc. Modic changes and disc herniations were, however, relatively rare.

Does Lumbar Disc Degeneration on Magnetic Resonance Imaging Associate With Low Back Symptom Severity in Young Finnish Adults

Study Design. A cross-sectional magnetic resonance imaging study with questionnaires on low back pain (LBP) and functional limitations. Objective. To investigate the association between lumbar intervertebral disc degeneration (DD) and low back symptom severity among young Finnish adults. Summary of Background Data. Both LBP and lumbar DD are common already in adolescence, but very little is known of their association in young adults. Methods. Young adults belonging to a birth cohort (n=874) were invited to lumbar magnetic resonance imaging using a 1.5-T scanner. Data on LBP and functional limitations at the ages of 18, 19, and 21 years were used to cluster the subjects with respect to low back symptoms using latent class analysis. The prevalence and 95% confidence intervals of DD at 21 years and the sum score of DD at all lumbar levels were compared between the clusters. The contribution of DD and other imaging findings (herniations, anular tears, Modic changes, spondylolytic defects) to symptom severity was analyzed with logistic regression analysis. Results. Latent class analysis produced five clusters from the 554 subjects, ranging from a cluster where subjects (n=65) had been painful at all time points to an asymptomatic cluster (n=168). DD was more prevalent in the three most symptomatic clusters compared to the two least symptomatic ones. Similar findings were obtained for the DD sum scores. Lumbar DD was related to symptom severity independently of other degenerative findings. Moreover, moderately degenerated discs were more likely than mildly degenerated discs to be associated with the most severe low back symptoms. Conclusion. Intervertebral DD was associated with low back symptom severity among young adults, suggesting that the symptoms may have a discogenic origin at this age. However, DD was also found in one-third of asymptomatic subjects.

Genetic susceptibility of intervertebral disc degeneration among young Finnish adults

BackgroundDisc degeneration (DD) is a common condition that progresses with aging. Although the events leading to DD are not well understood, a significant genetic influence has been found. This study was undertaken to assess the association between relevant candidate gene polymorphisms and moderate DD in a well-defined and characterized cohort of young adults. Focusing on young age can be valuable in determining genetic predisposition to DD.MethodsWe investigated the associations of existing candidate genes for DD among 538 young adults with a mean age of 19 belonging to the 1986 Northern Finland Birth Cohort. Nineteen single nucleotide polymorphisms (SNP) in 16 genes were genotyped. We evaluated lumbar DD using the modified Pfirrmann classification and a 1.5-T magnetic resonance scanner for imaging.ResultsOf the 538 individuals studied, 46% had no degeneration, while 54% had DD and 51% of these had moderate DD. The risk of DD was significantly higher in subjects with an allele G of IL6 SNPs rs1800795 (OR 1.45, 95% CI 1.07-1.96) and rs1800797 (OR 1.37, 95% CI 1.02-1.85) in the additive inheritance model. The role of IL6 was further supported by the haplotype analysis, which resulted in an association between the GGG haplotype (SNPs rs1800797, rs1800796 and rs1800795) and DD with an OR of 1.51 (95% CI 1.11-2.04). In addition, we observed an association between DD and two other polymorphisms, SKT rs16924573 (OR 0.27 95% CI 0.07-0.96) and CILP rs2073711 in women (OR 2.04, 95% CI 1.07-3.89).ConclusionOur results indicate that IL6, SKT and CILP are involved in the etiology of DD among young adults.

Association of Modic Changes, Schmorl's Nodes, Spondylolytic Defects, High-Intensity Zone Lesions, Disc Herniations, and Radial Tears With Low Back Symptom Severity Among Young Finnish Adults

Study Design. A cross-sectional magnetic resonance imaging (MRI) study. Objective. We investigated the association among Modic changes, Schmorls nodes, spondylolytic defects, high-intensity zone lesions, radial tears, herniations, and low back symptom severity. Summary of Background Data. Disc degeneration is associated with low back pain in early adulthood, but the associations between other MRI findings and low back pain are not well known. Methods. Questionnaire data and MRI scans (1.5-T) were available for 554 subjects derived from a birth cohort at 21 years of age. Data on low back pain and back-related functional limitations at 18, 19, and 21 years of age were used for clustering of subjects, using latent class analysis. We used logistic regression with adjustment for the degree of disc degeneration to evaluate the associations between specific imaging findings and low back symptom severity. Results. The prevalence of herniations was 20%, Schmorls nodes 17%, radial tears 9.9%, high-intensity zone lesions 3.2%, spondylolytic defects 5.8%, and Modic changes 0.7%. Latent class analysis produced 5 clusters: “Always Painful” (n = 65) meant painful at all time points and “Recent Onset Pain” (n = 56) meant increasing symptom severity, whereas subjects in the “Moderately Painful” (n = 73), “Minor Pain” (n = 193), and “No Pain” (n = 167) clusters had fewer symptoms. Compared with the “No Pain” cluster, Schmorls nodes were more likely to occur in the “Always Painful” cluster (P = 0.017) and herniations in the 3 most painful clusters (P < 0.001). Herniations were associated with low back symptom severity (odds ratio, 2.5; 95% confidence interval, 1.4–4.4). Schmorls nodes and radial tears were associated with symptoms in crude analyses only, whereas high-intensity zone lesions and spondylolytic defects occurred in similar frequencies in all clusters. Conclusion. Herniations were most likely in the subjects with recent onset or persistent (3-yr period) low back symptoms, although they were also detected in subjects with no symptoms. The clinical relevance of herniations on MRI remains to be evaluated in the context of symptoms.

Association of Abdominal Obesity with Lumbar Disc Degeneration - A Magnetic Resonance Imaging Study

Purpose To evaluate whether midsagittal (abdominal) obesity in magnetic resonance imaging (MRI), waist circumference (WC) and body fat percentage are associated with lumbar disc degeneration in early adulthood. Methods We obtained the lumbar MRI (1.5-T scanner) of 325 females and 233 males at a mean age of 21 years. Lumbar disc degeneration was evaluated using Pfirrmann classification. We analysed the associations of MRI measures of obesity (abdominal diameter (AD), sagittal diameter (SAD), ventral subcutaneous thickness (VST), and dorsal subcutaneous thickness (DST)), WC and body fat percentage with disc degeneration sum scores using ordinal logistic regression. Results A total of 155 (48%) females and 147 (63%) males had disc degeneration. AD and SAD were associated with a disc degeneration sum score of ≥3 compared to disc degeneration sum score of 0–2 (OR 1.67; 95% confidence interval (CI) 1.20–2.33 and OR 1.40; 95% CI 1.12–1.75, respectively) among males, but we found no association among females. WC was also associated with disc degeneration among males (OR 1.03 per one cm; 95% CI 1.00–1.05), but not among females. Conclusion Measures of abdominal obesity in MRI and waist circumference were associated with disc degeneration among 21-year-old males.

Assessment of association between low back pain and paraspinal muscle atrophy using opposed-phase magnetic resonance imaging: a population-based study among young adults.

Study Design. A cross-sectional imaging study of young adults. Objective. To evaluate whether severity of low back symptoms predicts atrophy in the paraspinal muscles of young adults. Summary of Background Data. Although an increased fat content of the lumbar muscles has been observed among adults with chronic LBP, there is limited knowledge of this association in younger populations. Methods. The population-based study sample consisted of 554 subjects (321 females and 233 males) from the 1986 Northern Finland Birth Cohort. Latent Class Analysis (LCA) was used to cluster the subjects according to the low back symptoms and functional limitations at 18, 19, and 21 years. The mean age of the subjects at the time of the MRI (magnetic resonance imaging) was 21 years (range, 20–23). Muscle atrophy was evaluated by assessing the fat content of the paraspinal muscles using Opposed-Phase MRI. The cross-sectional areas (CSAs) of the erector spinae and multifidus muscles were also measured. Results. LCA analysis produced five clusters differing in symptoms, ranging from a cluster (n = 65) in which subjects had high likelihood of symptoms and functional limitations at all time points, to a cluster (n = 165) with no pain ever. The fat content of the multifidus muscles was significantly higher among women than men (14.0% vs. 5.3%, P < 0.001), but it was not significantly associated with symptom severity. The CSA of both erector spinae and multifidus muscles were significantly larger among men than women (P < 0.001 in all of the muscles), but were not associated with pain severity. Conclusion. Low back symptoms and functional limitations over a 3-year period were not associated with increased fat content or a reduction in the cross-sectional area of lumbar paraspinal muscles among young adults.

Body mass index is associated with lumbar disc degeneration in young Finnish males: subsample of Northern Finland birth cohort study 1986

BackgroundThe role of environmental factors in lumbar intervertebral disc degeneration (DD) in young adults is largely unknown. Therefore, we investigated whether body mass index (BMI), smoking, and physical activity are associated with lumbar DD among young adults.MethodsThe Oulu Back Study (OBS) is a subpopulation of the 1986 Northern Finland Birth Cohort (NFBC 1986) and it originally included 2,969 children. The OBS subjects received a postal questionnaire, and those who responded (N = 1,987) were invited to the physical examination. The participants (N = 874) were invited to lumbar MRI study. A total of 558 young adults (325 females and 233 males) underwent MRI that used a 1.5-T scanner at the mean age of 21. Each lumbar intervertebral disc was graded as normal (0), mildly (1), moderately (2), or severely (3) degenerated. We calculated a sum score of the lumbar DD, and analyzed the associations between environmental risk factors (smoking, physical activity and weight-related factors assessed at 16 and 19 years) and DD using ordinal logistic regression, the results being expressed as cumulative odds ratios (COR). All analyses were stratified by gender.ResultsOf the 558 subjects, 256 (46%) had no DD, 117 (21%) had sum score of one, 93 (17%) sum score of two, and 92 (17%) sum score of three or higher. In the multivariate ordinal logistic regression model, BMI at 16 years (highest vs. lowest quartile) was associated with DD sum score among males (COR 2.35; 95% CI 1.19-4.65) but not among females (COR 1.29; 95% CI 0.72-2.32). Smoking of at least four pack-years was associated with DD among males, but not among females (COR 2.41; 95% CI 0.99-5.86 and 1.59; 95% 0.67-3.76, respectively). Self-reported physical activity was not associated with DD.ConclusionsHigh BMI at 16 years was associated with lumbar DD at 21 years among young males but not among females. High pack-years of smoking showed a comparable association in males, while physical activity had no association with DD in either gender. These results suggest that environmental factors are associated with DD among young males.

Influence of physical activity on vertebral strength during late adolescence

BACKGROUND CONTEXT Reduced vertebral strength is a clear risk factor for vertebral fractures. Men and women with vertebral fractures often have reduced vertebral size and bone mineral density (BMD). Vertebral strength is controlled by both genetic and developmental factors. Malnutrition and low levels of physical activity are commonly considered to result in reduced bone size during growth. Several studies have also demonstrated the general relationship between BMD and physical activity in the appendicular skeleton. PURPOSE In this study, we wanted to clarify the role of physical activity on vertebral bodies. Vertebral dimensions appear to generally be less pliant than long bones when lifetime changes occur. We wanted to explore the association between physical activity during late adolescence and vertebral strength parameters such as cross-sectional size and BMD. STUDY DESIGN The association between physical activity and vertebral strength was explored by measuring vertebral strength parameters and defining the level of physical activity during adolescence. PATIENT SAMPLE The study population consisted of 6,928 males and females who, at 15 to 16 and 19 years of age, responded to a mailed questionnaire inquiring about their physical activity. A total of 558 individuals at the mean age of 21 years underwent magnetic resonance imaging (MRI) scans. METHODS We measured the dimensions of the fourth lumbar vertebra from the MRI scans of the Northern Finland Birth Cohort 1986 and performed T2* relaxation time mapping, reflective of BMD. Vertebral strength was based on these two parameters. We analyzed the association of physical activity on vertebral strength using the analysis of variance. RESULTS AND CONCLUSIONS We observed no association between the level of physical activity during late adolescence and vertebral strength at 21 years.

Association between adolescent sport activities and lumbar disk degeneration among young adults

The relationship between different sport activities and lumbar intervertebral disk degeneration (DD) is largely unknown. We evaluated whether adolescent participation in different sports is associated with lumbar DD in a population‐based birth cohort of young adults. A total of 558 young adults (325 females and 233 males) underwent magnetic resonance imaging (MRI, 1.5‐T scanner). A DD sum score, based on the Pfirrmann grading, was calculated for all lumbar levels. The sum score was categorized into no DD, 1, 2, or at least 3. Participation in different sport activities was self‐reported by postal surveys at 16, 18, and 19 years, and three groups were formed based on participation frequency in 11 sports: (a) highly active (at least twice a week), (b) moderately active (2‐4 times a month), and (c) inactive (maximum once a month). Cumulative odds ratios (COR) and their 95% confidence intervals (CI) were obtained for each sport by ordinal logistic regression, adjusting for gender, body mass index, age, socioeconomic status, smoking, and other sports. Highly active participation in jogging/running and swimming was associated with a higher DD sum score (COR: 3.0; 95% CI: 1.4‐6.3 and 5.0; 1.7‐15.2, respectively) compared to inactive participation, whereas highly active participation in skating showed low COR. In conclusion, running and swimming at least twice a week in early adulthood are potentially associated with lumbar DD. Follow‐up studies with MRI are needed to show whether frequent exposure to running or swimming has further effect on the integrity of lumbar intervertebral disks.

Association of Body Mass Index in Early Childhood with Lumbar Disk Degeneration at 21 Years

Introduction There are no studies on association between early childhood body mass index and lumbar disk degeneration (DD) later. Materials and Methods The Oulu back study includes children who belong to the Northern Finland Birth Cohort 1986 and have been followed up to 21 years. Data from child health clinic records were used to derive BMI at birth, at adiposity peak (AP), and at adiposity rebound (AR). Lumbar MRI was performed using a 1.5-T scanner at the age of 21. Lumbar intervertebral disks were graded as normal (0), mildly (1), moderately (2), or severely (3) degenerated. The sum score of lumbar DD was categorized as 0, 1 to 2, or at least 3. The associations of BMI at birth, AP, and AR with DD were analyzed using multinomial logistic regression with and without adjustment for relevant confounders. All analyses were stratified by gender. Results Of the 520 scanned subjects, 46% had no DD, 38% had sum score of 1 or 2, and 16% had sum score of at least 3. In the univariate models, BMI at birth among females and BMI at AR among males were positively associated with DD sum score of at least 3 (OR 1.3; 95% CI, 1.0–1.7 and OR 1.8; 95% CI, 1.1–2.7, respectively). In adjusted models, the results weakened among females, while among males the associations between BMI at AP and AR with DD sum score of at least 3 strengthened (OR 2.0; 95% CI, 1.1–3.7 and OR 2.2; 95% CI, 1.4–3.7). Conclusion High BMI at AP and AR in early childhood increased the likelihood of lumbar DD at the age of 21 among males. This novel finding may help to understand the pathomechanisms of DD. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared