Disc degeneration in low back pain: a 17-year follow-up study using magnetic resonance imaging.

STUDY DESIGN: A prospective, cohort clinical and magnetic resonance imaging (MRI) study of patients with low back pain.

OBJECTIVE: To study if lumbar disc degeneration (DD), diagnosed in young patients with low back pain by using MRI will predict chronic pain, disc herniation, or functional disability after a 17-year follow-up.

SUMMARY OF BACKGROUND DATA: In 1987, 75 male Finnish conscripts aged 20 years, with low back pain hindering their military service, were studied using MRI at 0.02 T.

METHODS: In 2003, 32 patients were reexamined with MRI at 1.0 T. The history of low back illness during the follow-up and current functional outcome were recorded.

RESULTS: In 1987, 69% of the 32-patient cohort had DD in one or more lumbar discs. In 2003, all subjects had DD in MRI. The mean number of degenerated discs in each subject increased from 1.1 to 3.0. A total of 76% of discs degenerated in 1987 were herniated in 2003, whereas only 29% of well-hydrated discs in 1987 were herniated at the time of follow-up (P = 0.0002). During 17 years of follow-up, 3 patients had undergone spinal surgery.

CONCLUSIONS: Early DD in adolescent patients with low back pain predicted the evolution of enhanced DD and herniation in adulthood, but it was not associated with severe low back pain or increased frequency of spinal surgery.