Radiological changes of spine in patients with chronic low back ache

Abstract

OBJECTIVE: To determine the association between causes such as disc space narrowing, vertebral osteophytes and spondylolisthesis with chronic low backache among Sri Lankan adults. METHODOLOGY: A case control study was done at the Teaching hospital Ragama and Rehabilitation hospital Ragama Sri Lanka. Postero- anterior and lateral radiographs of the lumbo- sacral spine of a hundred and thirty cases and a hundred and thirty three controls were studied. The cases and controls were matched for age and sex. All radiographs were read by two radiologists working independently for the presence of verebral osteophytes, spondylolisthesis and disc space narrowing. The results were analysed by applying chi squared test for bivariate associations and logistic regression for multivariate associations. RESULTS: The age range of the study subjects was 18-82 years. Mean (SD) age for cases was 49.3 years (15 years); Mean (SD) age for controls was 51.4 years (17 years). There were 81 (62.3%) females with low backache and 82 (61.7%) females without low backache. Disc space narrowing was present in 15% of cases and 2% of controls. A person with disc space narrowing had a 7 times greater chance of developing low backache compared to a person without disc space narrowing (OR = 6.8, P= 0.008). Vertebral osteophytes were present in 72% of cases and 64% of controls. Spondylolisthesis was present in 8% of cases and 7% of controls. Vertebral osteophytes and spondylolisthesis did not have a significant association with low backache. Conclusion: Among the radiological features of the lumbar spine, disc space narrowing was the only feature with a significant association with low backache.