Background/Purpose: Little is known of the relationships between low back symptoms (LBS) and associated leg symptoms and lumbar spine individual radiographic features (IRF).  We examined the associations between LBS, with and without associated leg symptoms, and lumbar spine IRF of disc space narrowing (DSN), vertebral osteophytes (OST) and facet joint osteoarthritis (FOA) and determined if these associations differed by race or gender.

Methods: 840 newly enrolled participants in the Johnston County Osteoarthritis Project from 2003-04 having data on lumbar spine IRF (DSN, OST and FOA) were the subjects (mean age 60.1 (SD 10.3), 62.3% female, 37.6% African American, mean body mass index (BMI) 31.3 (SD 7.4)). Lateral lumbar spine films were graded for each lumbar level in a semi-quantitative fashion (0-3) for DSN and OST according to the Burnett Atlas, while FOA was graded present or absent. Low back symptoms with and without associated leg symptoms were determined with the following questions “On most days have you had symptoms of pain, aching or stiffness in your low back? “and “ On most days do you have pain (sciatica) radiating down your right or left leg?” Two outcome groups were created: LBS and LBS with associated leg symptoms. Each group was compared separately to those with no symptoms. Logistic regression models were used for all analyses while adjusting for BMI, race, gender and age. Interactions between lumbar spine IRF and race or gender were tested with likelihood ratios tests (p<0.10 for significance).

Results: Low back symptoms and LBS with associated leg symptoms were present in 51.8% and 24.9% of participants, respectfully. Disc space narrowing was present in 57.6%, OST present in 88.1% and FOA present in 57.9% of participants. Those with LBS were 32% as likely than those without LBS to have DSN (adjusted odds ratio [aOR] 1.32 ((95% CI 1.09, 1.52)). No association was found with FOA and either LBS or LBS with associated leg symptoms. No significant association was found between OST and LBS with associated leg symptoms.

A significant interaction (p<0.001) was observed between race and OST with LBS. African Americans (AAs) with OST were more likely (aOR 1.78 ((95% CI 1.25, 2.55)) to report LBS than AAs without OST. There was no effect among Caucasians.

Conclusion: Modest associations were found between DSN and LBS but no significant associations were found with LBS and associated leg symptoms. LBS with associated leg symptoms may have an etiology other than disc degeneration; suggesting that plain film radiographs may have limited clinical utility for this subgroup.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-relationship-between-lumbar-spine-individual-radiographic-features-and-low-back-symptoms-with-and-without-associated-leg-symptoms-the-johnston-county-osteoarthritis-project/