Pilot Study: Characteristics of Lumbar Disc Disease in Patients Who Centralize their Symptoms

Background: Despite increases in healthcare cost for back pain (BP), there is little improvement in patient outcomes. Although BP is most commonly linked with lumbar disc disease (LDD), diagnosis remains unclear, making cost-effective care difficult. However, BP patients reporting centralization of symptoms (CS) have demonstrated improved outcomes; these patients may also have LDD. This pilot’s purpose was, referencing LDD-linked genetic markers (MMP2-1306, VDR-352T, IL6-597A_G) and MRI (Modic changes), to describe LDD characteristics in patients with CS. Methods: Genetic marker, MRI and clinical (CS, historical, laboratory) data from 12 patients with BP were compared with 10 previously-studied controls. Results: All subjects were similar in age, height and activity levels. 9 of 12 patients and all controls showed negligible pathology on MRI. Patients showed greatest prevalence of MMP2-1306C= 1.00 (1.00, 1.00); VDR-352T= 0.67 (0.35, 0.98); and IL6-597A_G= 0.58 (0.26, 0.91) genetic variants; all controls showed an absence of IL6-597A variant, but similar prevalence of the MMP2- 1306C and VDR-352T variants to patients. Patients had greater BMI (p= 0.018) and number offalls/accidents (p= 0.015). 10 patient’s reporting CS also had zero-to-negligible pathological bone (CTx) or cartilage (COMP) degradation, inflammation (Hs-CRP) or bone production (BAP) compared to patients without CS or controls. Conclusions: Expanded study is warranted to employ the described MRI/ genetic reference criteria proposed for LDD in patients with CS, obesity, and biomechanical trauma.