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Findings support disc prolapse and disc degeneration as distinct diseases
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SCOTTSDALE, Ariz. — Investigators from India discovered several significant differences between patients with acute disc prolapse and patients with low back pain and disc degeneration including the severity, pattern and level of disc degeneration distribution, indicating these as separate conditions.
“Disc prolapse patients and disc degeneration patients differ significantly in the pattern and severity of disc degeneration,” Rishi M. Kanna, MS, MRCS, FNB, said at the International Society for the Study of the Lumbar Spine Meeting, here. “Probably, they are two different diseases, and the mechanical etiology can be proposed possibly for disc prolapse because they [had] predominately more [disc degeneration] in the lower lumbar spine and with significant endplate damage, where as the opposite was true for the disc degeneration group, and we can probably say that there is a genetic element to this.”
Rishi M. Kanna
To analyze the characteristics of disc degeneration in the whole lumbar spine, Kanna and colleagues prospectively studied 91 patients with acute sciatica due to a single-level disc prolapse who had positive nerve root signs, MRI evidence of a significant disc herniation and pain for less than 4 weeks and 133 patients with chronic low back pain and disc degeneration without sciatica.
The investigators found patients in the disc degeneration group had a higher percentage of degenerated discs than patients in the disc prolapse group (51% vs. 38%). In addition, multilevel lumbar degeneration and lumbar degeneration where all five discs were involved was more common in the disc degeneration group.
The groups also showed significant differences in the pattern of involvement of their degeneration. In the disc degeneration group, 51% of involvement was confined to the lower two lumbar levels compared to 81% of the disc prolapse group. The total endplate score was more affected in the disc prolapse patients.
“Interestingly, [for] the modic change, the disc prolapse group had 47% compared to 27% in the disc degeneration group,” Kanna said.
Reference:
Kanna RM. Paper #10. Presented at: The International Society for the Study of the Lumbar Spine Meeting. May 13-17, 2013; Scottsdale, Ariz.
Disclosure: Kanna has no relevant financial disclosures.