Degenerative disc disease as a cause of back pain in the thalassaemic population : a case-control study using MRI and plain radiographs

• Published in: Skeletal radiology 2006-02, Vol.35 (2), p.95-102
• Main Authors: DESIGAN, S, HALL-CRAGGS, M. A, HO, C-P, ELIAHOO, J, PORTER, J. B
• Format: Article
• Language: English
• Subjects: Anemias. Hemoglobinopathies; Back Pain - diagnosis; Back Pain - epidemiology; Biological and medical sciences; Case-Control Studies; Causality; Comorbidity; Digestive system; Diseases of red blood cells; Diseases of the osteoarticular system; Diseases of the spine; Hematologic and hematopoietic diseases; Humans; Intervertebral Disc Displacement - diagnosis; Intervertebral Disc Displacement - epidemiology; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging - statistics & numerical data; Medical sciences; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiography - statistics & numerical data; Retrospective Studies; Risk Assessment - methods; Risk Factors; Spine; Thalassemia - diagnosis; Thalassemia - epidemiology; United Kingdom - epidemiology
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-005-0020-1

The aim of this study was to test our observation that back pain in thalassemic patients could be caused by premature and extensive lumbar degenerative disc disease, when compared to non-thalassemic patients with back pain. Sixteen thalassemic patients with their sex- and age-matched controls were recruited into the study, 12 with thalassemia major, and 4 with thalassemia intermedia. Both the thalassemia patients and control subjects suffered from back pain, which was subjective rather than measured/pain scored. All subjects underwent magnetic resonance (MR) imaging of the lumbar spine, and 11 of the cases and 8 controls had lumbar spine radiographs. Each lumbar disc was scored for radiographic appearances and MR features of disc degeneration and disc protrusion. Proportion values for these parameters and median scores were derived at each disc level, and were analyzed and compared. There was a statistically-significant difference between proportion values of cases and controls for the MR features (P value=0.01, n=16) and the radiographic features (P value=0.01, n=11 cases, n=8 controls) of disc degeneration. The median disc level scores for the thalassemic group were uniformly high across all lumbar discs, and at all levels except at L 4/5. The control group conversely demonstrated a predilection for disc degeneration at L4/5 level. The distribution of lumbar disc degeneration in thalassemic patients with back pain is more extensive, severe and multi-level in nature compared to matched controls, and disc degeneration should be considered as a significant cause of back pain in this population group.