A single degenerate intervertebral disc is suggested to promote rapid degeneration in its adjacent discs. We validated this hypothesis using discordant co-twin case-control design. 185 pairs of twins were selected from the TwinsUK database having cervical MRI scans at baseline and at follow-up, after 10 years. Isolated disc degeneration (IDD) was diagnosed in subjects having severe loss in disc height (graded 3/3) in a single disc, whilst discs immediately adjacent manifested little or no degeneration (graded 0 or 1). The controls' ‘adjacent discs’ were considered at the same levels as their affected co-twins.Objectives
Methods
T2D is postulated to be an important aetiological factor for lumbar disc degeneration (LDD), which itself has a well documented relationship with low back pain. Obesity increases risk of both T2D, low back pain and LDD. Connective tissue modification has been reported in hyperglycaemia, but the epidemiology of LDD in T2D has not been described to date. A population sample of unselected same-sex adult twin pairs was studied who had attended a spine MR study and completed general health questionnaires defining T2D by self-report. LDD had been coded as the sum of five lumbar discs coded (0–3) for each of height, signal intensity, disc bulge and anterior osteophytes. Risk factors for LDD included age, body-mass index (BMI), sex, alcohol consumption and smoking. Mean age of the 1011 participants = 54 years (sd=8), mean BMI=25 kg/m2 (sd=4), 95% female. The prevalence of T2D was 6%. Twins with T2D had increased BMI (27 vs 25 kg/m2, p<0.001) and were older (59 vs 54 years, p<0.001). LDD score in T2D was significantly higher in diabetic cases than controls (14.9 vs 13.1, p=0.04) in univariable analysis. In multivariable analysis inclusion of age and BMI abrogated the effect of T2D.Background and aims:
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