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Obesity Is Associated With Reduced Disc Height in the Lumbar Spine but Not at the Lumbosacral Junction

Urquhart, Donna M. PhD*; Kurniadi, Ivan BMedSci(Hons)*; Triangto, Kevin BMedSci(Hons)*; Wang, Yuanyuan PhD*; Wluka, Anita E. PhD*; O'Sullivan, Richard MD†,‡; Jones, Graeme MD§; Cicuttini, Flavia M. PhD*

doi: 10.1097/BRS.0000000000000411
Epidemiology

Study Design. Cross-sectional, community-based study.

Objective. To investigate the relationships between obesity, disc height, and low back pain in the lumbosacral spine.

Summary of Background Data. Although obesity is a recognized risk factor for low back pain, our understanding of the mechanisms for this is limited. The evidence for an association between obesity and spinal structural changes is also conflicting.

Methods. Seventy-two participants from a community-based study of musculoskeletal health underwent magnetic resonance imaging from the T12 vertebral body to the sacrum. Disc height was measured from L1–L2 to L5–S1. Body mass index was measured and low back pain in the previous 2 weeks was assessed.

Results. The mean and total lumbar disc heights were reduced in obese individuals compared with nonobese individuals (mean height (standard error):1.04 (0.03) cm vs. 1.14 (0.02) cm, P = 0.01; total height (standard error):4.16 (0.11) cm vs. 4.57 (0.10) cm, P = 0.01), after adjusting for age, sex, and height. Although obesity was associated with reduced disc heights at the L1–L2 and L3–L4 levels, there were no significant relationship at the lumbosacral junction (mean difference (95% confidence interval [CI]):0.10 (−0.14 to 0.16) cm, P = 0.89). Both mean and total lumbar disc heights were negatively associated with recent pain after adjusting for age, sex, and height (mean height: mean difference (95% CI):0.09 (0.02–0.17) cm, P = 0.02; total height: mean difference (95% CI): 0.37 (0.07–0.66) cm, P = 0.02). However, these relationships were no longer significant when we also adjusted for weight (mean height; mean difference (95% CI):0.07(−0.009 to 0.15) cm, P = 0.08; total height: mean difference (95% CI):0.28 (−0.04 to 0.60) cm, P = 0.08). There were no significant relationships between disc height and recent pain at the lumbosacral junction.

Conclusion. Obesity was associated with reduced disc height in the lumbar spine, but not at the lumbosacral junction, suggesting these joints may have different risk factors. There was also evidence for an inter-relationship between obesity, lumbar disc height, and recent pain, suggesting that structural changes have a role in back pain and may in part explain the association between obesity and back pain.

Level of Evidence: 3

This study examined the relationship between obesity and lumbosacral disc height in community-based individuals. Obesity was associated with a reduced disc height in the lumbar spine, but not at the lumbosacral junction, and may mediate the relationship between recent pain and lumbar disc height.

*Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia

Healthcare Imaging Services, Epworth Hospital, Richmond, Victoria, Australia

Department of Medicine, Central Clinical School, Monash University, Alfred Centre, Melbourne, Victoria, Australia; and

§Menzies Research Institute, Hobart, Tasmania, Australia.

Address correspondence and reprint requests to Donna M. Urquhart, PhD, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne 3004, Victoria Australia; E-mail: Donna.Urquhart@monash.edu

Acknowledgment date: November 7, 2013. Revision date: March 10, 2014. Acceptance date: April 15, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Monash University Strategic Grant Scheme funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins