Skip to main content

Advertisement

Log in

Low Back Pain and Lumbar Spine Osteoarthritis: How Are They Related?

  • CHRONIC PAIN (LJ CROFFORD, SECTION EDITOR)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Lumbar spine osteoarthritis (OA) is very common, with estimates of prevalence ranging from 40–85 %. The process of degeneration of the spine has commonly been classified as OA (disc space narrowing together with vertebral osteophyte formation); however, anatomically, the facet joint is the only synovial joint in the spine that has a similar pathological degenerative process to appendicular joints. Low back pain (LBP) is also a common condition, with nearly 80 % of Americans experiencing at least one episode of LBP in their lifetime. The complex relationship between spine radiographs and LBP has many clinical and research challenges. Specific conservative treatments for spine degeneration have not been established; there has, however, been recent interest in use of exercise therapy, because of some moderate benefits in treating chronic LBP. An understanding of the relationship between spine degeneration and LBP may be improved with further population-based research in the areas of genetics, biomarkers, and pain pathways.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Paper of particular interest, published recently, have been highlighted as: • Of importance, •• Of major importance

  1. Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58(1):26–35.

    Article  PubMed  Google Scholar 

  2. Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991–94. J Rheumatol. 2006;33(11):2271–9.

    PubMed  Google Scholar 

  3. Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum. 2006;54(1):226–9.

    Article  PubMed  Google Scholar 

  4. Kennedy DJ, Fredericson M. Introduction. Pm R. 2012;4(5 Suppl):S1–2.

    Article  PubMed  Google Scholar 

  5. Battie MC, Videman T, Parent E. Lumbar disc degeneration: epidemiology and genetic influences. Spine (Phila Pa 1976). 2004;29(23):2679–2690.

  6. Borenstein D. Does osteoarthritis of the lumbar spine cause chronic low back pain? Curr Rheumatol Rep. 2004;6(1):14–9.

    Article  PubMed  Google Scholar 

  7. Rubin DI. Epidemiology and risk factors for spine pain. Neurol Clin. 2007;25(2):353–71.

    Article  PubMed  Google Scholar 

  8. Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88 Suppl 2:21–4.

    Article  PubMed  Google Scholar 

  9. Guo HR, Tanaka S, Halperin WE, Cameron LL. Back pain prevalence in US industry and estimates of lost workdays. Am J Public Health. 1999;89(7):1029–35.

    Article  PubMed  CAS  Google Scholar 

  10. Ricci JA, Stewart WF, Chee E, Leotta C, Foley K, Hochberg MC. Back pain exacerbations and lost productive time costs in United States workers. Spine. 2006;31(26):3052–60.

    Article  PubMed  Google Scholar 

  11. Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003;290(18):2443–54.

    Article  PubMed  CAS  Google Scholar 

  12. Weiner DK, Haggerty CL, Kritchevsky SB, Harris T, Simonsick EM, Nevitt M, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain Med. 2003;4(4):311–20.

    Article  PubMed  Google Scholar 

  13. Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine (Phila Pa 1976). 1995;20(1):11–19.

  14. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. 2002;137(7):586–97.

    PubMed  Google Scholar 

  15. Chou R, Qaseem A, Snow V, Casey D, Cross Jr JT, Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478–91.

    PubMed  Google Scholar 

  16. Smith-Bindman R, Miglioretti DL, Larson EB. Rising use of diagnostic medical imaging in a large integrated health system. Health Aff (Millwood). 2008;27(6):1491–1502.

    Google Scholar 

  17. Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, et al. The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169(3):251–8.

    Article  PubMed  Google Scholar 

  18. Carey TS, Freburger JK, Holmes GM, Castel L, Darter J, Agans R, et al. A long way to go: practice patterns and evidence in chronic low back pain care. Spine (Phila Pa 1976). 2009;34(7):718–724.

  19. van Tulder MW, Assendelft WJ, Koes BW, Bouter LM. Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies. Spine. 1997;22(4):427–34.

    Article  PubMed  Google Scholar 

  20. Varlotta GP, Lefkowitz TR, Schweitzer M, Errico TJ, Spivak J, Bendo JA, et al. The lumbar facet joint: a review of current knowledge: part 1: anatomy, biomechanics, and grading. Skeletal Radiol. 2011;40(1):13–23.

    Article  PubMed  Google Scholar 

  21. Kalichman L, Hunter DJ. Lumbar facet joint osteoarthritis: a review. Semin Arthritis Rheum. 2007;37(2):69–80.

    Article  PubMed  Google Scholar 

  22. Videman T, Battie MC, Gill K, Manninen H, Gibbons LE, Fisher LD. Magnetic resonance imaging findings and their relationships in the thoracic and lumbar spine. Insights into the etiopathogenesis of spinal degeneration. Spine. 1995;20(8):928–35.

    Article  PubMed  CAS  Google Scholar 

  23. Urban JPG, Roberts S, Ralphs JR. The nucleus of the intervertebral disc from development to degeneration. Amer Zool. 2000;40(1):53–61.

    Article  Google Scholar 

  24. Eyre DR, Muir H. Quantitative analysis of types I and II collagens in human intervertebral discs at various ages. Biochim Biophys Acta. 1977;492(1):29–42.

    Article  PubMed  CAS  Google Scholar 

  25. Antoniou J, Steffen T, Nelson F, Winterbottom N, Hollander AP, Poole RA, et al. The human lumbar intervertebral disc: evidence for changes in the biosynthesis and denaturation of the extracellular matrix with growth, maturation, ageing, and degeneration. J Clin Invest. 1996;98(4):996–1003.

    Article  PubMed  CAS  Google Scholar 

  26. Menkes CJ, Lane NE. Are osteophytes good or bad? Osteoarthritis and cartilage 2004;12 Suppl A:S53–54.

  27. Snodgrass JJ. Sex differences and aging of the vertebral column. J Forensic Sci. 2004;49(3):458–63.

    Article  PubMed  Google Scholar 

  28. Alonge TO, Oni OO. An investigation of the frequency of co-existence of osteophytes and circumscribed full thickness articular surface defects in the knee joint. Afr J Med Med Sci. 2000;29(2):151–3.

    PubMed  CAS  Google Scholar 

  29. Boegard T, Rudling O, Petersson IF, Jonsson K. Correlation between radiographically diagnosed osteophytes and magnetic resonance detected cartilage defects in the tibiofemoral joint. Ann Rheum Dis. 1998;57(7):401–7.

    Article  PubMed  CAS  Google Scholar 

  30. • Suri P, Miyakoshi A, Hunter DJ, Jarvik JG, Rainville J, Guermazi A, et al. Does lumbar spinal degeneration begin with the anterior structures? A study of the observed epidemiology in a community-based population. BMC Musculoskelet Disord. 2011;12:202. This was an ancillary study using data from the Framingham Heart Study to determine if the anterior structures of the spine degenerate in sequence to the posterior structures of the spine. For most participants, anterior structure degeneration occurred before posterior; however, there were cases of posterior structure degeneration in isolation of anterior structures, suggesting that facet joint OA may occur without intervertebral disc degeneration.

  31. Nuki G. Osteoarthritis: a problem of joint failure. Z Rheumatol. 1999;58(3):142–7.

    Article  PubMed  CAS  Google Scholar 

  32. •• Muraki S, Akune T, Oka H, Ishimoto Y, Nagata K, Yoshida M, et al. Incidence and risk factors for radiographic lumbar spondylosis and lower back pain in Japanese men and women: the ROAD study. Osteoarthritis Cartilage. 2012;20(7):712–718. This is one of few longitudinal studies aimed at determining the incidence of lumbar spondylosis changes and risk factors for progression. Findings from this study indicate an overall high proportion of Kellgren–Lawrence (K-L) graded lumbar spondylosis. The incidence of K-L ≥ 2 was greater among men, as was the progression of lumbar spondylosis. Severe K-L grade at baseline was significantly associated with the incidence of low back pain.

  33. Hassett G, Hart DJ, Manek NJ, Doyle DV, Spector TD. Risk factors for progression of lumbar spine disc degeneration: the Chingford Study. Arthritis Rheum. 2003;48(11):3112–7.

    Article  PubMed  CAS  Google Scholar 

  34. •• de Schepper EI, Damen J, van Meurs JB, Ginai AZ, Popham M, Hofman A, et al. The association between lumbar disc degeneration and low back pain: the influence of age, gender, and individual radiographic features. Spine (Phila Pa 1976). 2010;35(5):531–536. This is the largest population-based study describing the prevalence and associations with low back pain of individual radiographic features of disc space narrowing and vertebral osteophytes. Their findings indicate a significant association between disc space narrowing and vertebral osteophytes and low back pain. However, the associations with vertebral osteophytes were small and have not been replicated in other studies. This is also the first study to determine the relationship between spine radiographic features and physical function with some associations being stronger than with low back pain alone.

  35. •• Goode A, Marshall, SW, Renner, JB, Carey, TS, Kraus, VB, Irwin, DE, Sturmer, T, Jordan, JM. Lumbar spine radiographic features and demographic, clinical and concomitant knee, hip and hand OA: The Johnston County Osteoarthritis Project [in press]. Arthritis Care Res. 2012. This is the only community-based study in the US of spine radiographic features and their relationship between hip, knee, and hand OA and low back symptoms. Only disc space narrowing was significantly associated with low back symptoms. Associations differed by appendicular joint OA with significant associations between facet joint OA and knee and hand OA, but no associations between disc space narrowing and knee or hand OA. No radiographic feature in the spine was associated with hip OA. This was also the first study to determine that associations between spine radiographic features differed by race.

  36. Muraki S, Oka H, Akune T, Mabuchi A, En-Yo Y, Yoshida M, et al. Prevalence of radiographic lumbar spondylosis and its association with low back pain in elderly subjects of population-based cohorts: the ROAD study. Ann Rheum Dis. 2009;68(9):1401–6.

    Article  PubMed  CAS  Google Scholar 

  37. Pye SR, Reid DM, Smith R, Adams JE, Nelson K, Silman AJ, et al. Radiographic features of lumbar disc degeneration and self-reported back pain. J Rheumatol. 2004;31(4):753–8.

    PubMed  Google Scholar 

  38. Dionne CE, Dunn KM, Croft PR, Nachemson AL, Buchbinder R, Walker BF, et al. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine (Phila Pa 1976). 2008;33(1):95–103.

  39. Kalichman L, Li L, Kim DH, Guermazi A, Berkin V, O’Donnell CJ, et al. Facet joint osteoarthritis and low back pain in the community-based population. Spine. 2008;33(23):2560–5.

    Article  PubMed  Google Scholar 

  40. •• Scheele J, de Schepper EI, van Meurs JB, Hofman A, Koes BW, Luijsterburg PA, et al. Association between spinal morning stiffness and lumbar disc degeneration: the Rotterdam Study. Osteoarthritis and cartilage 2012. This study is the first to describe the involvement of morning stiffness in combination with low back pain among those with spine degeneration. The associations between self reported morning stiffness in conjunction with low back symptoms were stronger than self reported low back pain alone. These findings are of particular importance because self-reported low back pain has only had modest associations with spine degeneration.

  41. Symmons DP, van Hemert AM, Vandenbroucke JP, Valkenburg HA. A longitudinal study of back pain and radiological changes in the lumbar spines of middle aged women. II. Radiographic findings. Ann Rheum Dis. 1991;50(3):162–6.

    Article  PubMed  CAS  Google Scholar 

  42. Symmons DP, van Hemert AM, Vandenbroucke JP, Valkenburg HA. A longitudinal study of back pain and radiological changes in the lumbar spines of middle aged women. I. Clinical findings. Ann Rheum Dis. 1991;50(3):158–61.

    Article  PubMed  CAS  Google Scholar 

  43. Bigos SJ, Holland J, Holland C, Webster JS, Battie M, Malmgren JA. High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. Spine J. 2009;9(2):147–68.

    Article  PubMed  Google Scholar 

  44. Buchbinder R, Pransky G, Hayden J. Recent advances in the evaluation and management of nonspecific low back pain and related disorders. Best Pract Res Clin Rheumatol. 2010;24(2):147–53.

    Article  PubMed  Google Scholar 

  45. Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005(3):CD000335.

  46. Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147(7):492–504.

    PubMed  Google Scholar 

  47. •• Sherman KJ, Cherkin DC, Wellman RD, Cook AJ, Hawkes RJ, Delaney K, et al. A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Arch Intern Med. 2011;171(22):2019–2026. This randomized clinical trial examined stretching, yoga, and self-care books for primary care patients. Although not specific to spine degeneration, these findings indicate that yoga was more effective than self-care books but no more effective than stretching classes for the treatment of chronic low back pain. Both types of intervention resulted in improved symptoms and increased physical function with benefits lasting for several months. These results support several other reports that some exercise is better than no exercise for low back pain.

  48. Karppinen J, Shen FH, Luk KD, Andersson GB, Cheung KM, Samartzis D. Management of degenerative disk disease and chronic low back pain. Orthop Clin North Am. 2011;42(4):513–528, viii.

    Google Scholar 

  49. Manchikanti L, Singh V, Pampati V, Smith HS, Hirsch JA. Analysis of growth of interventional techniques in managing chronic pain in the Medicare population: a 10-year evaluation from 1997 to 2006. Pain Physician. 2009;12(1):9–34.

    PubMed  Google Scholar 

  50. Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34(10):1078–93.

    Article  PubMed  Google Scholar 

  51. van Spil WE, DeGroot J, Lems WF, Oostveen JC, Lafeber FP. Serum and urinary biochemical markers for knee and hip-osteoarthritis: a systematic review applying the consensus BIPED criteria. Osteoarthritis Cartilage. 2010;18(5):605–12.

    Article  PubMed  Google Scholar 

  52. Gruber HE, Hanley EN. Do we need biomarkers for disc degeneration? Biomark Insights. 2007;1:131–3.

    PubMed  Google Scholar 

  53. Garnero P, Sornay-Rendu E, Arlot M, Christiansen C, Delmas PD. Association between spine disc degeneration and type II collagen degradation in postmenopausal women: the OFELY study. Arthritis Rheum. 2004;50(10):3137–44.

    Article  PubMed  Google Scholar 

  54. Meulenbelt I, Kloppenburg M, Kroon HM, Houwing-Duistermaat JJ, Garnero P, Hellio Le Graverand MP, et al. Urinary CTX-II levels are associated with radiographic subtypes of osteoarthritis in hip, knee, hand, and facet joints in subject with familial osteoarthritis at multiple sites: the GARP study. Ann Rheum Dis. 2006;65(3):360–5.

    Article  PubMed  CAS  Google Scholar 

  55. •• Goode A, Marshall, SW, Kraus, VB, Renner, JB, Sturmer, T, Carey, TS, Irwin, DE, Jordan, JM. Association between serum and urine biomarkers and individual radiographic features in the spine: The Johnston County Osteoarthritis Project [in press]. Osteoarthritis Cartilage. 2012. This study examined a broad range of urine and serum biomarkers and their associations with either disc space narrowing or vertebral osteophytes. Associations between biomarkers and disc space narrowing were stronger than association of biomarkers with vertebral osteophytes. This is the only study to compare a wide range of biomarkers among those with and without low back symptoms. Interestingly, serum COMP was significantly associated with disc space narrowing among those with low back symptoms but not among those without low back symptoms.

  56. Zhang Y, Sun Z, Liu J, Guo X. Advances in susceptibility genetics of intervertebral degenerative disc disease. Int J Biol Sci. 2008;4(5):283–90.

    Article  PubMed  CAS  Google Scholar 

  57. Kalichman L, Hunter DJ. The genetics of intervertebral disc degeneration. Associated genes. Joint Bone Spine. 2008;75(4):388–96.

    Article  PubMed  CAS  Google Scholar 

  58. Chan D, Song Y, Sham P, Cheung KM. Genetics of disc degeneration. Eur Spine J. 2006;15 Suppl 3:S317–325.

    Article  PubMed  Google Scholar 

  59. Ala-Kokko L. Genetic risk factors for lumbar disc disease. Ann Med. 2002;34(1):42–7.

    Article  PubMed  CAS  Google Scholar 

  60. Kao PY, Chan D, Samartzis D, Sham PC, Song YQ. Genetics of lumbar disk degeneration: technology, study designs, and risk factors. Orthop Clin North Am. 2011;42(4):479–486, vii.

    Google Scholar 

  61. Arendt-Nielsen L, Nie H, Laursen MB, Laursen BS, Madeleine P, Simonsen OH, et al. Sensitization in patients with painful knee osteoarthritis. Pain. 2010;149(3):573–81.

    Article  PubMed  Google Scholar 

  62. Imamura M, Imamura ST, Kaziyama HH, Targino RA, Hsing WT, de Souza LP, et al. Impact of nervous system hyperalgesia on pain, disability, and quality of life in patients with knee osteoarthritis: a controlled analysis. Arthritis Rheum. 2008;59(10):1424–31.

    Article  PubMed  Google Scholar 

  63. Goode A, Shi, XA, Renner, JR, Gracely, R, Maleki-Fischban, M, Jordan, JM. Association Between Pain Threshold, Symptoms and Radiographic Knee and Hip Osteoarthritis: The Johnston County Osteoarthritis Project [accepted abstract]. Arthritis Rheum. 2012.

  64. Giesecke T, Williams DA, Harris RE, Cupps TR, Tian X, Tian TX, et al. Subgrouping of fibromyalgia patients on the basis of pressure-pain thresholds and psychological factors. Arthritis Rheum. 2003;48(10):2916–22.

    Article  PubMed  Google Scholar 

  65. Petzke F, Clauw DJ, Ambrose K, Khine A, Gracely RH. Increased pain sensitivity in fibromyalgia: effects of stimulus type and mode of presentation. Pain. 2003;105(3):403–13.

    Article  PubMed  Google Scholar 

  66. Giesecke T, Gracely RH, Grant MA, Nachemson A, Petzke F, Williams DA, et al. Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis Rheum. 2004;50(2):613–23.

    Article  PubMed  Google Scholar 

  67. O’Neill S, Kjaer P, Graven-Nielsen T, Manniche C, Arendt-Nielsen L. Low pressure pain thresholds are associated with, but does not predispose for, low back pain. Eur Spine J. 2011;20(12):2120–5.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Dr Goode is supported by the NIH Loan Repayment Program, the National Institute of Arthritis Musculoskeletal and Skin Diseases (1-L30-AR057661-01), and by the Agency for Health Care Research and Quality (AHRQ) K-12 Comparative Effectiveness Career Development Award grant number HS19479-01. The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the NIAMS or AHRQ.

The authors would like to thank Holly R. Thompson, BA, for her careful editing of the manuscript.

Disclosure

Dr Goode has received grant support from the Agency for Health Care Research and Quality. Dr Carey has served as a consultant for Blue Cross and the Blue Shield Association. Dr Jordan has received grant support from Johnson and Johnson, has received honoraria from LEK Consulting and Marston Consulting, holds stock options in Algynomics, and has had travel and/or accommodation expenses covered and/or reimbursed by the Osteoarthritis Research Society International and the Arthritis Foundation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Adam P. Goode.

Additional information

This article is part of the Topical Collection on Chronic Pain

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goode, A.P., Carey, T.S. & Jordan, J.M. Low Back Pain and Lumbar Spine Osteoarthritis: How Are They Related?. Curr Rheumatol Rep 15, 305 (2013). https://doi.org/10.1007/s11926-012-0305-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11926-012-0305-z

Keywords

Navigation