Degenerative disc disease as a cause of back pain in the thalassaemic population: a case-control study using MRI and plain radiographs |
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Authors: | S Desigan M A Hall-Craggs C-P Ho J Eliahoo J B Porter |
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Institution: | (1) Department of Imaging, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK;(2) Research and Development Directorate, University College London Hospitals NHS Trust, Vezey Strong Building, 112 Hampstead Road, London, NW1 2LT, UK;(3) Department of Haematology, University College London Hospitals NHS Trust, University College Hospital, Grafton Way, London, W1CE 6DB, UK |
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Abstract: | Purpose The aim of this study was to test our observation that back pain in thalassemic patients could be caused by premature and
extensive lumbar degenerative disc disease, when compared to non-thalassemic patients with back pain.
Methods and materials Sixteen thalassemic patients with their sex- and age-matched controls were recruited into the study, 12 with thalassemia major,
and 4 with thalassemia intermedia. Both the thalassemia patients and control subjects suffered from back pain, which was subjective
rather than measured/pain scored. All subjects underwent magnetic resonance (MR) imaging of the lumbar spine, and 11 of the
cases and 8 controls had lumbar spine radiographs. Each lumbar disc was scored for radiographic appearances and MR features
of disc degeneration and disc protrusion. Proportion values for these parameters and median scores were derived at each disc
level, and were analyzed and compared.
Results There was a statistically-significant difference between proportion values of cases and controls for the MR features (P value=0.01, n=16) and the radiographic features (P value=0.01, n=11 cases, n=8 controls) of disc degeneration. The median disc level scores for the thalassemic group were uniformly high across all lumbar
discs, and at all levels except at L 4/5. The control group conversely demonstrated a predilection for disc degeneration at
L4/5 level.
Conclusion The distribution of lumbar disc degeneration in thalassemic patients with back pain is more extensive, severe and multi-level
in nature compared to matched controls, and disc degeneration should be considered as a significant cause of back pain in
this population group. |
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Keywords: | Thalassemia Back pain Intervertebral disc Magnetic resonance imaging Diagnostic X-ray |
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