Facet joint parameters which may act as risk factors for chronic low back pain

Quality of lumbar paraspinal muscles in patients with chronic low back pain and its relationship to pain duration, pain intensity, and quality of life

OBJECTIVES

To examine the relationship between the quality of paraspinal muscles and pain intensity, duration, and quality of life in patients with chronic low back pain (cLBP).

METHODS

Between January 2022 and December 2023, 119 individuals with no-back pain (no-BP) and 136 cLBP patients were enrolled. Both groups underwent health surveys and magnetic resonance imaging. Cross-sectional area (CSA), functional cross-sectional area (FCSA), and fat infiltration (FI) of multifidus (MF) and erector spinae (ES) were measured. Data were analyzed using multiple linear and binary logistic regression.

RESULTS

Compared to the cLBP group, the no-BP group had smaller CSA influenced by FI of ES at L5/S1 (p = 0.01), higher FCSA of ES (p < 0.01) at L4/L5, and lower FI of ES and MF at L4/L5 and L5/S1 (p < 0.01). CSA, FCSA, and FI showed no significant correlation with cLBP intensity except for the CSA (p = 0.02) and FCSA (p = 0.03) of the L2/3 MF. Pain duration positively correlated with FI at L2/3, L3/4, and L4/5 of MF and ES (p < 0.05) and CSA of the L1/2 MF (p = 0.02). CSA (L3/4, L4/5, and L5/S1) and FCSA (L4/5, L5/S1) of MF correlated positively with SF36 scores (p < 0.05), while ES muscles did not (p > 0.05). FI of MF and ES showed no correlation with SF36 scores.

CONCLUSION

CSA and FI were significantly higher, and FCSA significantly lower in paraspinal muscles of cLBP patients compared to asymptomatic participants. Increased FI correlated with prolonged cLBP duration, indicating FI and FCSA alterations may play a significant role in cLBP development and duration.

KEY POINTS

Question What is the relationship between paraspinal muscle quality and cLBP, including its intensity, duration, and impact on quality of life? Findings cLBP patients had increased FI and reduced functional muscle area in paraspinal muscles, with FI correlating with prolonged pain duration. Clinical relevance Understanding the changes in lumbar paraspinal muscles provides insight into cLBP progression, guiding personalized interventions to improve pain management and patient quality of life.

Relationship Between Lumbar Multifidus Morphometry and Pain/Disability in Individuals With Chronic Nonspecific Low Back Pain After Considering Demographics, Fear-Avoidance Beliefs, Insomnia, and Spinal Degenerative Changes

Background

Although individuals with chronic low back pain (CLBP) show increased fatty infiltration in the lumbar multifidus muscle (LMM), it remains unclear whether LMM changes are related to clinical outcomes (such as pain and disability) after considering confounders (spinal phenotypes, fear-avoidance beliefs [FABs] and insomnia). This study examined: (1) differences in confounders and LMM characteristics between individuals with and without CLBP; and (2) associations between confounders, LMM parameters, and clinical outcomes in the CLBP group alone.

Methods

Participants (CLBP = 70 and asymptomatic people = 67) underwent lumbar magnetic resonance imaging. Outcome measures comprised the numeric pain rating scale, the Roland-Morris Disability Questionnaire, the Fear-Avoidance Beliefs Questionnaire (FABQ), and the Insomnia Severity Index (ISI) Scale. LMM morphometry at L3-S1 (cross-sectional area, total volume, and fatty infiltration) was measured using a customized MATLAB program. Spinal phenotypes (disc degeneration, high-intensity zones, Modic changes [MCs], Schmorl's nodes, facet joint degeneration [FJD], and facet tropism [FT]) were scored. The between-group differences were analyzed using linear mixed models and chi-squared/Fisher's exact tests. Univariate and multivariate analyses evaluated associations between clinical outcomes and other outcome measures in the CLBP group.

Results

The CLBP group demonstrated more severe disc degeneration and FJD at all levels, and greater FT at L5/S1 than asymptomatic participants (p < 0.05). The average LMM total volume at L3/4 and the percentage of fatty infiltration in LMM in the L3-S1 region were greater in the CLBP group than in asymptomatic counterparts (p < 0.05). The presence of MC at L4 and FJD at L4/5 and L4-S1 was significantly related to pain intensity in the CLBP group. Similarly, FABQ-Work and ISI scores were significantly related to pain intensity (explaining 37% of the variance in pain).

Conclusions

The CLBP group displays more fatty infiltration in the LMM, but their LMM morphometric parameters are unrelated to pain/disability after considering spinal phenotypes, FABs, and insomnia.

Enhancing Clinical Insights: New Radiographic Grading for Lumbar Facet Joint Degeneration, A Reliability Study

Background

Lumbar facet joint diseases can often lead to reduced work efficiency and increased medical costs. As a primary imaging tool in orthopedics, X-rays offer numerous advantages. However, there is no consensus on the classification of lumbar facet joints based on X-ray imaging.

Methods

This study was conducted for 356 patients between November 2017 and September 2023. A senior radiologist and a senior orthopedic surgeon discussed and established a grading system for lumbar facet joints based on both X-ray and MRI findings. Two double-blind attending spinal surgeons were asked to evaluate and grade the included cases. The intra-rater reliability and inter-rater reliability were evaluated by assessing the weighted kappa (κw) coefficient.

Results

The level of inter-rater reliability of MRI for complete agreement was good for Doctor A (κw = 0.792) and Doctor B (κw = 0.869). The inter-rater reliability coefficient for grading lumbar facet joint degeneration based on the radiograph was as follows: for Doctor A (κw = 0.702, session 1; κw = 0.847, session 2) and Doctor B (κw = 0.714, session 1; κw = 0.828, session 2). Moreover, the level of intra-rater reliability based on X-ray for complete agreement was excellent for Doctor A (κw = 0.843) and Doctor B (κw = 0.836).

Conclusion

We propose a new grading system for lumbar facet joint degeneration based on X-rays, which serves as a supplement to the Weishaupt and Pathria classifications. This grading system aims to provide clinicians with a more comprehensive understanding of lumbar facet joint degeneration, allowing for the use of a broader range of diagnostic tools to evaluate facet joint degeneration from multiple perspectives. We believe that this grading system can be valuable in assessing potential anatomical changes related to the facet joint, thereby informing modifications to surgical techniques and procedural steps.

Correlation Between Facet Tropism and Ossification of the Posterior Longitudinal Ligament in the Cervical Spine

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

To explore the correlation between Facet Tropism (FT) and OPLL in cervical spine.

METHODS

One-hundred patients with OPLL of cervical spine and one-hundred normal participants without OPLL or cervical disc herniation were included in this study, the patients were matched to the normal participants respectively based on the same sex and similar age (±5). For patients, the cervical levels with and without OPLL were categorized into "OPLL group" and "patient control group," respectively. Bilateral facet joint angles at C2/3-C6/7 were measured on sagittal, coronal, and axial planes on CT.

RESULTS

On every planes at the level of C2/3-C6/7,the mean difference between left and right facet angles and FT incidence in the most levels of the OPLL group were significantly greater than those in the control groups (P < 0.001). At the most cervical levels, there was no significant difference in mean difference of facet angles and FT incidence between the 2 control groups. On the axial plane, the incidence of FT in segmental type OPLL patients was significantly higher than that in continuous type OPLL patients (P = 0.036). On the coronal plane, the incidence of FT in segmental type OPLL was significantly higher than that in the other OPLL types (P < 0.001), and local type OPLL had a higher incidence of FT compared to mixed type OPLL (P = 0.016). On the sagittal plane, the incidence of FT in segmental type OPLL was higher than that in continuous type OPLL (P = 0.019) and mixed type OPLL (P = 0.036).

CONCLUSIONS

There is a significant correlation between OPLL of cervical spine and FT. There are significant differences in the incidence of FT among different cervical OPLL types.

Preliminary evaluation of a novel method for computed tomography quantification of lumbosacral articular process displacement in dogs with and without degenerative lumbosacral stenosis

Objective

This study aimed to describe the diagnostic discrimination and reliability of a novel technique for quantifying lumbosacral articular process displacement (LSAPD) on dorsal plane computed tomography (DPCT) imaging in dogs with and without degenerative lumbosacral stenosis (DLSS).

Study design

DPCT surveys of the lumbosacral vertebral column were performed with dogs positioned in extension and flexion. LSAPD is defined as the distance between the cranial aspects of the L7 and S1 articular processes. The LSAPD ratio is identified by dividing the LSAPD by the length of the L7 articular process. Intraclass correlation coefficients (ICCs) for intra- and inter-observer reliability were calculated, and logistic regressions were used to test for the association of LSAPD and LSAPD ratio with odds of DLSS. Significance was set at 0.05. Receiver operator characteristic (ROC) curves were calculated to determine diagnostic discrimination and optimal cutoff for LSAPD and LSAPD ratio in the diagnosis of DLSS.

Results

Intra- and inter-observer reliabilities were excellent for most measurements. In the current cohort, excluding covariates, the area under the curve (AUC) (95%CI) for LSAPD and LSAPD ratio measured in a flexed position were both 0.89 (0.82-0.96), suggesting potentially excellent discrimination for using this measurement as a marker for diagnosing DLSS, pending further studies. The cutoffs for flexed LSAPD and LSAPD ratio that maximizes Youden's index were ≥ 1.2 mm and ≥ 9%, respectively. When age and weight were subsequently included as covariates in a multivariable analysis, a significant relationship between LSAPD or LSAPD ratio and odds of diagnosis of DLSS was not demonstrated, suggesting the need for a larger sample size.

Conclusion

The results of this study suggest that measurements of LSAPD and LSAPD ratio on DPCT are feasible and reliable, although their diagnostic discrimination in DLSS should be evaluated further in future prospective studies.

Are there correlations between facet joint parameters and lumbar disk herniation laterality in young adults?

OBJECTIVE

We aimed to determine whether there is an association, in young adults, between the occurrence of lumbar disk herniation (LDH) at a given segment and the segment's facet joint parameters [facet orientation (FO) and tropism (FT)]. In addition, associations between facet joint parameters in the corresponding segment and LDH laterality were also investigated.

METHODS

We retrospectively analyzed data from 529 patients who were between 18 and 35 years old, who had experienced single-level LDH (L4-5 or L5-S1) between June 2017 and December 2019, and with<2 years of clinical history. We included an additional 122 patients with no history of LDH as an age-matched control group. LDH were classified by laterality (left-sided, right-sided, or central herniation). At each level, we investigated the relationship between facet joint parameters and herniation laterality.

RESULTS

FO_A values at the L4-L5 level and the L5-S1 level were significantly lower and FT was higher for the LDH group compared with those for the control group. The level at which LDH occurred, FO_L, FO_R, and FT differed significantly among the three groups. There was a significant association between herniationlaterality and FO at the L4-L5 level but not at the L5-S1 level.

CONCLUSIONS

Abnormal facet joint parameters are significantly associated with LDH. Young adults with higher FT should be paid more attention, to prevent the occurrence of LDH. Compared with L5-S1 level, intervertebral disk herniation at the L4-L5 level tended to occur ipsilateral to the side with a lower facet joint angle when FT was present.

Development and Validation of a Risk-Prediction Nomogram for Chronic Low Back Pain Using a National Health Examination Survey: A Cross-Sectional Study

BACKGROUND

Several prognostic factors have been reported for chronic low back pain (CLBP). However, there are no studies on the prediction of CLBP development in the general population using a risk prediction model. This cross-sectional study aimed to develop and validate a risk prediction model for CLBP development in the general population, and to create a nomogram that can help a person at risk of developing CLBP to receive appropriate counseling on risk modification.

METHODS

Data on CLBP development, demographics, socioeconomic history, and comorbid health conditions of the participants were obtained through a nationally representative health examination and survey from 2007 to 2009. Prediction models for CLBP development were derived from a health survey on a random sample of 80% of the data and validated in the remaining 20%. After developing the risk prediction model for CLBP, the model was incorporated into a nomogram.

RESULTS

Data for 17,038 participants were analyzed, including 2693 with CLBP and 14,345 without CLBP. The selected risk factors included age, sex, occupation, education level, mid-intensity physical activity, depressive symptoms, and comorbidities. This model had good predictive performance in the validation dataset (concordance statistic = 0.7569, Hosmer-Lemeshow chi-square statistic = 12.10, p = 0.278). Based on our model, the findings indicated no significant differences between the observed and predicted probabilities.

CONCLUSIONS

The risk prediction model presented by a nomogram, which is a score-based prediction system, can be incorporated into the clinical setting. Thus, our prediction model can help individuals at risk of developing CLBP to receive appropriate counseling on risk modification from primary physicians.

Prevalence of chronic low back pain and its associated factors in the general population of South Korea: a cross-sectional study using the National Health and Nutrition Examination Surveys

BACKGROUND

Many factors associated with chronic low back pain (CLBP) have been proposed, including individual, psychosocial, and physical factors. However, these associated factors are still controversial.

PURPOSE

(1) To determine the prevalence of CLBP and (2) to analyze factors associated with CLBP in the general population using a nationally representative sample of South Koreans.

STUDY DESIGN

Cross-sectional study.

PATIENT SAMPLE

Data from versions IV-1, -2, and -3 of the Korea National Health and Nutrition Examination Survey (KNHANES), which were performed in 2007, 2008, and 2009, respectively (n = 24,871).

OUTCOME MEASURES

Multiple logistic regression analysis was performed to determine the association between several factors (age, gender, alcohol consumption, household income, education level, mid-intensity physical activity, depressive symptoms, vitamin D level, and comorbidities [stroke, ischemic heart disease, knee osteoarthritis, asthma, COPD, cancer history]) and CLBP.

METHODS

CLBP status was surveyed using a self-reported questionnaire. Demographic, socioeconomic status, comorbidities, and other factors were evaluated from health questionnaires, health and physical examinations, and laboratory tests. To analyze the association between these factors and CLBP, we used multiple logistic regression analysis.

RESULTS

Data from 17,038 participants were included in the final analysis, including 2,693 with CLBP and 14,345 without. The prevalence of CLBP was 15.8% in South Korean subjects, with a prevalence of 11.8% in men and 24.5% in women. After regression analysis, we found advanced age, female gender, mid-intensity physical activity, depressive symptoms, stroke, ischemic heart disease, knee arthritis, asthma, COPD, and cancer history were positively associated with CLBP. In contrast, alcohol consumption ≥ 1 drink per month, increased household income, higher education level, and vitamin D insufficiency were negatively associated with CLBP.

CONCLUSIONS

Our study showed that CLBP was most common in the elderly and women in the general South Korean population. Several individual, socioeconomic, lifestyle, and health-related factors were associated with CLBP. These results demonstrate the influence of these factors on CLBP in the general population and suggest that consideration of these factors may improve the management of CLBP.

Facet Joint Syndrome: Pathophysiology, Diagnosis, and Treatment

Facet joint osteoarthritis (OA) is the most frequent form of facet joint syndrome. Medical history, referred pain patterns, physical examination, and diagnostic imaging studies (standard radiographs, magnetic resonance imaging, computed tomography and single-photon emission computed tomography) may suggest but not confirm lumbar facet joint (LFJ) syndrome as a source of low back pain (LBP). However, the diagnosis and treatment of facet joint syndrome is still controversial and needs further study. It is widely acknowledged that block with local anesthetic is perhaps the most effective method to establish a diagnosis of pain from LFJ. Particularly, there are different rates of success among different populations selected for diagnostic block with various positive criteria. Currently, in addition to conservative treatments for pain such as painkillers, functional exercises, and massage, there are many other methods, including block, denervation of the nerves that innervate the joints by radiofrequency, freezing or endoscopy, and injections. Due to the limited duration of pain relief from neurolysis of medial branch, many scholars have recently turned their targets to dorsal roots and LFJ capsules. Therefore, we reviewed the latest research progress of facet joint syndrome from diagnosis to treatment.

Influence of the facet joint angle on facet joint degeneration following pedicle screw fixation without fusion in thoracolumbar fractures

BACKGROUND

Posterior approach pedicle screw fixation without fusion is widely used in the treatment of neurologically intact type A3 thoracolumbar fractures.

OBJECTIVE

To analyze the influence of the facet joint (FJ) angle on FJ degeneration following posterior approach pedicle screw fixation without fusion in neurologically intact type A3 thoracolumbar fractures.

METHODS

Fifty-eight patients who underwent pedicle screw fixation via the traditional posterior approach (n= 28) or the Wiltse approach (n= 30) were enrolled. A CT scan was performed before fixation and before fixation removal (Within 1.5 to 2 years after fixation) to evaluate the FJs parameters, including FJ inclination (FJI), FJ tropism (FJT), FJ violation, and FJ degeneration grade (FJDG), of three fixed segments and the adjacent segment below the fixed segments.

RESULTS

There was no significant difference in FJ violation rate, FJDG deterioration, or FJ angle between the two groups (P> 0.05). FJDG deterioration showed a weak positive correlation with FJI and FJT before fixation, and the angular change in FJI (P< 0.05); and FJT before fixation and the angular change in FJI were risk factors for FJDG deterioration (P< 0.01).

CONCLUSION

The Wiltse approach did not increase the rate of FJDG deterioration and FJs angle changes. However, the FJT before fixation and the angular change in FJI were risk factors for FJDG deterioration.

Effect of Facet Tropism on Postoperative Cervical Range of Motion After Single-Level Cervical Disc Arthroplasty

STUDY DESIGN

Retrospective analysis.

OBJECTIVES

Cervical disc arthroplasty (CDA) was designed to replace the degenerated disc with the prosthesis to preserve cervical motion. The commonly used artificial discs are designed symmetric, whereas the facet joints were reported to be asymmetric in many people. This study aimed to evaluate the effect of facet tropism on the cervical range of motion (ROM) after single-level CDA using Prestige LP.

METHODS

A total of 90 patients who underwent single-level CDA using Prestige LP from 2012 to 2017 were retrospectively reviewed. Radiographs were taken at each time point to measure the C2-C7 ROM and the ROM at the surgical segment. The pre-operation CT scans were utilized to reconstruct and calculate the angular direction of facet joints with respect to transverse, coronal, and sagittal reference planes. Facet tropism above 7° was defined as facet joint asymmetry.

RESULTS

No significant difference was found in flexion-extension C2-C7 ROM or ROM at the surgical segment between patients with symmetric and asymmetric fact joints regarding the sagittal plane. Patients with coronal asymmetric facet joints had lower flexion-extension ROM at the surgical level. Patients with transverse asymmetric facet joints had both lower flexion-extension C2-C7 ROM and ROM at the surgical level. After CDA surgery, patients obtained good clinical outcomes including increased Japanese Orthopedic Association (JOA) and decreased Neck Disability Index (NDI) as well as Visual Analogue Scale (VAS).

CONCLUSION

The coronal and transverse tropism seemed to be correlated with decreased flexion-extension ROM after CDA using Prestige LP.

Quantitative Radiological Characteristics of the Facet Joints in Patients with Lumbar Foraminal Stenosis

Purpose

This study aimed to evaluate the degeneration patterns of the facet joints (FJs) in patients with lumbar foraminal stenosis (LFS) and investigate the correlation between quantitative parameters and FJ osteoarthritis (FJ OA).

Patients and Methods

A total of 171 patients with LFS at the L4/5 level and 146 control patients were enrolled in this study. The severity of FJ OA was graded according to the Weishaupt classification. The FJ orientation, FJ tropism, superior articular process cross-sectional area (SAPA), and FJ area were measured at the L3/4, L4/5, and L5/S1 spinal levels. Associations among the parameters were assessed using Pearson's correlation coefficients. Independent sample t-tests and Pearson's chi-square tests were used for univariate analyses. The association between LFS and the quantitative parameters was also analyzed using multivariate logistic regression models adjusted for age, gender, and body mass index.

Results

Patients with LFS had more sagittal FJ orientation (37.9 vs 45.0, p < 0.001), more FJ tropism (5.6 vs 3.8, p < 0.001), larger SAPA (129.0 vs 97.8, p < 0.001), and less FJ area (21.7 vs 23.3, p = 0.016). Logistic regression analysis showed that LFS was significantly associated with FJ tropism (odds ratio [OR]: 1.153; p = 0.003) and SAPA (OR: 1.113; p < 0.001). The SAPA showed the largest area under the curve (0.908, 95% confidence interval: 0.875-0.942) for the diagnosis of LFS. The optimal cutoff value was 114.75 mm2 with 85.4% sensitivity and 87.0% specificity. Additionally, a significant correlation was observed between FJ OA and SAPA and FJ area at each studied spinal level.

Conclusion

This study confirmed that LFS is significantly associated with FJ hypertrophy and tropism. FJ hypertrophy and joint space narrowing correlated with the severity of FJ OA. These results are helpful in understanding the morphology and pathology of FJs.

Facet tropism: Association between cervical disc degeneration and cervical spondylotic radiculopathy in middle-aged patients

This study aimed to retrospectively explore the relationship between facet tropism (FT) and cervical disc degeneration in cervical spondylotic radiculopathy (CSR) patients on 3-dimensional views. A total of 180 middle-aged patients with single-level CSR at C4/5 who underwent cervical CT and MRI in our hospital were included. The incidence of FT (or called FT (+), defined as FT ≥ 7 degree) at C3/4, C4/5, C5/6 levels were measured and calculated by reconstructed CT images on 3-dimensional views. The grade of cervical disc degeneration at three levels was assessed by MRI images by the method of Miyazali. Univariate analysis was performed to compare their cervical disc degeneration grade and CSR incidence between two groups stratified by FT (+). Moreover, a logistic regression model was used to investigate the association between FT (+) and grade of cervical disc degeneration and incidence of CSR adjusting for age, gender, and BMI. Grade of cervical disc degeneration and incidence of CSR in axial FT (+) group were both significantly increased compared to axial FT (-) group, while sagittal and coronal FT (+) groups showed no difference. Axial FT (+) was significantly associated with the grade of cervical disc degeneration and incidence of CSR. in middle-aged patients with CSR, axial FT (+) might be the risk factor for cervical disc degeneration but not sagittal and coronal FT (+). Also, axial FT (+) was positively associated with CSR incidence. Therefore, axial FT might play a vital role in the progression of cervical disc degeneration and CSR occurrence.

The biomechanical influence of facet joint parameters on corresponding segment in the lumbar spine: a new visualization method

BACKGROUND CONTEXT

Facet joints have been discussed as influential factors in the development of lumbar degeneration, which includes disc herniation and degenerative lumbar spondylolisthesis. Facet orientation (FO) and facet tropism (FT) are two important structural parameters of the lumbar facet joints. Many previous studies have focused on single parameter analysis of the lumbar spine. Owing to the correlation between independent variables, single-factor analysis cannot reflect the interaction between variables; however, there has been no corresponding biomechanical method developed to address this problem.

PURPOSE

To investigate the complex biomechanical influences on the lumbar spine when vertebral FO and FT are varied using finite element analysis (FEA) and contour maps visualization, and analyze the biomechanical role of facet joint structural parameters in the process of lumbar degenerative diseases.

STUDY DESIGN

A biomechanical modelling, analysis, and verification study was performed.

METHODS

A three-dimensional non-linear FEA model of 3 denucleated intervertebral discs (L2-3, L3-4, L4-5) with adjacent vertebral bodies (L2-L5) was created. Previously performed in vitro experiments provided experimental data for the range of motion in each load direction that was used for calibration. For 12 lumbar models, different facet joint angles relative to the sagittal plane at both L3-4 facet joints were simulated for 35°≤FO≤50° and 0°≤FT≤15°. By modifying different values of FO and FT, FEA simulation of different lumbar spine models was performed. Contour maps were used to visualize the FO- and FT-relevant data.

RESULTS

Under flexion, extension, and torsion moments, facet joint contact force and intradiscal stress increased with increasing FT. In the condition where FT remained 0° and increasing FO values, facet joint contact force and intradiscal stress remained low with no apparent increasing or decreasing trend when the model was under flexion, extension, and torsion moments. In the condition where FO and the FT values were varied at the same time, the highest force and stress regions in the contour maps were observed when all three types of moments were applied. Stress distributions of the L3-4 disc with different FT and FO values showed disc stress increased significantly with increases of FT and was concentrated on the ipsilateral region of the facet joint with the more sagittal orientation.

CONCLUSIONS

The combination of FO and FT has an important impact on the corresponding disc and facet joints, but FT played a more significant role. Moreover, disc stress was concentrated on the ipsilateral region of facet joint with greater sagittal orientation when FT existed. FT with high sagittal orientation may increase risk of recurrent LDH due to increase ipsilateral disc pressure.

CLINICAL SIGNIFICANCE

These biomechanical findings may help clinicians to understand the prognosis of some lumbar degenerative conditions.

Prevalence, Incidence, and Factors Associated With Non-Specific Chronic Low Back Pain in Community-Dwelling Older Adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis

Chronic low back pain (CLBP) is common among older adults. This systematic review aimed to summarize: (1) the prevalence and incidence of CLBP in older adults, and (2) demographic, psychological, and clinical factors positively/negatively associated with prevalence/incidence of CLBP among older adults. Four databases were searched to identify relevant publications. Ten studies (31,080 older adults) were included after being screened by 5 independent reviewers using predetermined criteria. The methodological quality of these studies was evaluated by standardized tools. The quality of evidence for all factors were appraised by modified GRADE for cohort studies. Twenty-eight and 1 factors were associated with a higher prevalence and a lower 5-year cumulative incidence of CLBP, respectively. No prognostic factor was identified. There was very limited to limited evidence that females, obesity, anxiety, depression, mental disorders, self-expectation of recovery, self-perceived health status, lifestyle (smoking, daily fluoride consumption), previous falls or lower body injury, retirement/disability due to ill health, family history of body pain, comorbidity (knee osteoarthritis, or chronic obstructive pulmonary disease with/without hypertension), weak abdominal muscles, leg pain, leg pain intensity, widespread pain, pain interference on functioning, use of pain medication, occupational exposure (driving for >20 years, or jobs involving bending/twisting for >10 years), disc space narrowing and severe facet osteoarthritis were significantly related to a higher prevalence of CLBP in older adults. However, very limited evidence suggested that intermediate level of leisure-time physical activity was associated with a lower prevalence of CLBP in older adults. Given the aging population and limited information regarding risk factors for CLBP in older adults, future high-quality prospective studies should identify relevant risk factors to help develop proper preventive and treatment strategies. PERSPECTIVE: Despite the high prevalence of non-specific chronic low back pain among older adults, there is only very limited to limited evidence regarding factors associated with a higher prevalence of chronic low back pain in this population. Given the aging population, high-quality prospective studies are warranted to address this gap.

Non-steroidal anti-inflammatory drugs and gabapentinoids for chronic lumbar pain: a Bayesian network meta-analysis of randomized controlled trials

INTRODUCTION

Several pharmacological therapies have been proposed for the management of chronic low back pain (LBP), but no consensus has been reached yet.

SOURCE OF DATA

Recent published literatures identified accessing PubMed, Google scholar, Embase and Scopus.

AREAS OF AGREEMENT

Exploring effective conservative alternatives to the surgical intervention is of especial interest.

AREAS OF CONTROVERSY

The efficacy and safety of non-steroidal anti-inflammatory drugs and gabapentinoids for chronic LBP are debated. Several clinical studies showed controversial results, and the most effective and safe class of drugs has not yet been clarified.

GROWING POINTS

The effects of selective and non-selective NSAIDs and gabapentinoids in chronic LBP are probably over-estimated.

AREAS TIMELY FOR DEVELOPING RESEARCH

The effect of behavioural changes, including exercise, should be explored, alone or in combination with drugs.