DEGENERATIVE DISPLACEMENT OF LUMBAR VERTEBRAE - A 25-YEAR FOLLOW-UP-STUDY IN FRAMINGHAM

Study Design. The authors assessed degenerative lumbar displacement in a population-based cohort of 217 men and 400 women who had lateral lu mbar radiographs performed at the mean age of 54 years and again at 79 years, and who had completed interviews on back symptoms and function al performance in connection with the follow-vp examination. Objective s. To assess the prevalence and incidence of degenerative slippage and its association with back pain and physical disability. Summary of Ba ckground Data. Degenerative displacement of lumbar vertebrae may cause instability, nerve root compression, and spinal stenosis. Its inciden ce in the older population and association with back pain and disabili ty are unknown. Methods. The authors assessed the prevalence and incid ence of degenerative slippage from lateral lumbar radiographs performe d 25 years apart and its association with back pain and physical disab ility from interviews performed in connection with the follow-up exami nation. Results. At the follow-up examination, 23 (12%) men and 100 (2 5%) women had developed degenerative slippage exceeding 3 mm; two of t hem had this already at the baseline. A forward displacement was found in 8 men and 76 women (P < 0.0001 for difference between the genders) and a backward one in 16 men and 35 women. On average, forward slip w as 18% +/- 5.5, and backward slip, 15% +/- 4.0 of the anteroposterior diameter of the vertebra below. At the time of the second lumbar radio graph, 39 (32%) of the subjects with slippage, compared with 90 (19%) of the controls, had pain, aching, or stiffness in their back on most days (P = 0.001). After adjustment for endplate sclerosis, wh ich was also related to pain (P = 0.015), slippage still had association With daily back symptoms (P = 0.009). However, Subjects with slippage had n ot experienced mor back symptoms during the preceding year or in earli er ages of life, and they did not report more disability than the cont rols. Conclusions. Degenerative displacement of lumbar vertebrae is co mmon in an older population and is associated with Increased prevalenc e of daily back symptoms However, two thirds of the subjects with dege nerative displacement do not report ongoing back symptoms and the diso rder is also unrelated to long-term back pain and physical disability.