Background/Purpose: Low back pain (LBP) is a prevalent condition. Plain film radiography is a commonly used imaging technique for this condition. Radiographic features (RF) such as disc space narrowing (DSN), osteophytes, spondylosis, endplate sclerosis, spondylolisthesis and facet joint osteoarthritis have all been debated as potential pain generators in the lumbar spine. The aim of this study is to: 1) determine the association between LBP and lumbar spine RF in both community and occupation-based groups; and 2) to determine if there are differences in these associations between these two groups.

Methods: A systematic electronic search of PubMed, EMBASE, CINAHL and Cochrane was conducted with keywords related to LBP and lumbar spine RFs. The search was restricted from inception of each respective database to April 2014. Inclusion criteria consisted of observational studies of adults (≥18 years) with and without non-specific LBP. Studies were excluded if they investigated LBP related to infection, malignancy or rheumatologic nature or were conducted in cadavers. Quality assessment was conducted with the Item Bank for Assessment of Risk of Bias and Precision for Observational Studies of Interventions or Exposures. Random effect models were used for all pooled analyses with associations represented by odds ratios (OR) and 95% confidence intervals (95% CI). Statistical heterogeneity was indicated with an I² value >50%. 

Results: Twenty-eight (22 community-based and 6 occupation-based) studies met the eligibility criteria consisting of 26,107 subjects. A significant, positive association was found between DSN and LBP that did not differ (p=0.22) between community (OR=1.47 ((95% CI 1.36-1.58)) and occupation-based studies (OR=1.76 ((95% CI 1.34 -2.33)). No significant statistical heterogeneity was present in either estimate (I²=0.0%). A significant association was found between spondylolisthesis and LBP in occupation-based studies (OR=2.21 ((95% CI 1.44 – 3.39)) that differed significantly (p<0.01) from community based studies (OR=1.12 ((95% CI 1.03 – 1.23)). These individual estimates were also homogeneous (I²<1.0%). The association between other radiographic features was modest (i.e., spondylosis and osteophytes) or non-significant (i.e., endplate sclerosis and facet joint osteoarthritis). Quality of included studies varied with the majority of studies demonstrating good quality.

Conclusion: A significant positive association was found with DSN and LBP that did not differ between community and occupational-based studies. The fact that no differences exist between these two groups may be related to the influence that genetic factors have on disc degeneration. A significant strong association was found between spondylolisthesis and LBP among the occupational group but was weakly associated in the community-based group, supporting spondylolisthesis as a potential unique pain generator in the lumbar spine.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-association-between-low-back-pain-and-radiographic-features-a-systematic-review-with-meta-analysis/