Identification of lumbar disc disease hallmarks: a large cross-sectional study.

Zhang J1, et al

BACKGROUND:
Lumbar disc disease has a disabling impact and a heavy burden on society. It mainly consists of lumbar disc degeneration (LDD) and lumbar disc herniation (LDH). The recently released lumbar disc nomenclature version 2.0 deepens our understanding however there is an urgent need to clarify the occurrence and distribution features of LDD and LDH in a large-scale sample.
RESULTS:
The occurrence of LDH and LDD was 14.18 and 44.23% respectively. Notably, lumbar spine
discs were more prone to LDD than LDH. L4/5 was the most frequent level in terms of LDH
(26.08%) and LDD (56.09%), followed by L5/S1 (LDH: 24.09%; LDD: 55.33%), then L3/4, L2/3 and L1/2 in ranking order. The prevalence of LDH and LDD in upper lumbar discs from L1/2 to L3/4 was significant lower than the average prevalence rate (P < 0.05). The mean age was 24.70 (±14.81) years for normal lumbar discs; 49.76 (±14.95) years for LDD; 37.01 (±12.91) years for LDH; 51.31(±15.00) years for LDD and LDH (P < 0.05). Modic changes, HIZ, spondylosis deformans and decreased disc height were linked with older age; whereas Schmorl node and lumbar disc sequestration were not associated with age (P < 0.05).
CONCLUSIONS:
The prevalence of LDD is 44.23%, higher than LDH which was14.18%. L4/5 and L5/S1 are the most frequent involved segments for the majority of lumbar disc diseases. Schmorl node occurs (1.6%) more frequently in the upper lumbar spine, independent of age. Modic changes (0.87%) are closely related with older age.