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Facet Joint Osteoarthritis and Low Back Pain in the Community-Based Population

Kalichman, Leonid, PT, PhD*; Li, Ling, MPH; Kim, David H., MD; Guermazi, Ali, MD; Berkin, Valery, MD*; O'Donnell, Christopher J., MD, MPH§¶; Hoffmann, Udo, MD, MPH; Cole, Rob*; Hunter, David J., MBBS, PhD*†

doi: 10.1097/BRS.0b013e318184ef95
Diagnostics
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Study Design. Cross-sectional study.

Objective. To evaluate the association between lumbar spine facet joint osteoarthritis (FJ OA) identified by multidetector computed tomography (CT) and low back pain (LBP) in the community-based Framingham Heart Study.

Summary of Background Data. The association between lumbar FJ OA and LBP remains unclear.

Methods. This study was an ancillary project to the Framingham Heart Study. A sample of 3529 participants of the Framingham Heart Study aged 40 to 80 underwent multidetector CT imaging to assess aortic calcification. One hundred eighty-eight individuals were consecutively enrolled in this ancillary study to assess radiographic features associated with LBP. LBP in the preceding 12 months was evaluated using a self-report questionnaire. FJ OA was evaluated on CT scans using a 4-grade scale. The association between FJ OA and LBP was examined used multiple logistic regression models, while adjusting for gender, age, and BMI.

Results. CT imaging revealed a high prevalence of FJ OA (59.6% of males and 66.7% of females). Prevalence of FJ OA increases with age. By decade, FJ OA was present in 24.0% of <40-years-olds, 44.7% of 40- to 49-years-olds, 74.2% of 50- to 59-years-olds, 89.2% of 60- to 69-year-olds, and 69.2% of >70-years-olds. By spinal level the prevalence of FJ OA was: 15.1% at L2–L3, 30.6% at L3–L4, 45.1% at L4–L5, and 38.2% at L5–S1. In this community-based population, individuals with FJ OA at any spinal level showed no association with LBP.

Conclusion. There is a high prevalence of FJ OA in the community. Prevalence of FJ OA increases with age with the highest prevalence at the L4–L5 spinal level. At low spinal levels women have a higher prevalence of lumbar FJ OA than men. In the present study, we failed to find an association between FJ OA, identified by multidetector CT, at any spinal level and LBP in a community-based study population.

In the cross-sectional study we found a high prevalence of lumbar facet joint osteoarthritis (FJ OA) identified by computed tomography in a community-based population. Prevalence of FJ OA increases with age. The highest prevalence is in L4–L5 spinal level. FJ OA at any spinal level showed no association with low back pain.

From the *Boston University School of Medicine, Boston, MA;†Division of Research, New England Baptist Hospital, Boston, MA;‡Department of Radiology, Boston University School of Medicine, Boston, MA; §National Heart, Lung and Blood Institute and its Framingham Heart Study, Framingham, MA; ¶Cardiology Division, MA General Hospital, Harvard Medical School, Boston, MA; and ∥Cardiac MR CT PET Program, Department of Radiology, MA General Hospital, Harvard Medical School, Boston, MA.

Acknowledgment date: March 28, 2008. First revision date: June 6, 2008. Acceptance date: June 9, 2008.

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

Federal funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

This work was supported by the National Heart, Lung, and Blood Institute's Framingham Heart Study contract (No. N01-HC-25195) for the recruitment, enrollment, and examination of the Offspring and Third Generation Cohort and the imaging by computed tomography scan. L.K. is supported by an Arthritis Foundation Postdoctoral Grant.

Address correspondence and reprint requests to David J. Hunter, Chief, Division of Research, New England Baptist Hospital, 125 Parker Hill Ave, Boston MA. 02120; E-mail: djhunter@caregroup.harvard.edu

© 2008 Lippincott Williams & Wilkins, Inc.