TY - JOUR

T1 - A comparison of approaches to studying relationships between lumbar spinal degeneration findings demonstrates advantages to interspace-level analyses over person-level analyses

AU - Suri, Pradeep

AU - Elgaeva, Elizaveta

AU - Jarvik, Jeffrey

AU - Rundell, Sean

AU - Tsepilov, Yakov

AU - Williams, Frances

AU - Heagerty, Patrick

N1 - Funding was provided by National Institute of Arthritis and Musculoskeletal and Skin Diseases (Grant Number P30AR072572), Russian Science Foundation (Grant Number 22-15-20037) and Government of the Novosibirsk region, Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (Grant Number FWNR-2022-0020).

PY - 2025/6/10

Y1 - 2025/6/10

N2 - Purpose: To examine associations between lumbar intervertebral disc degeneration (LDD) and type II Modic changes (MC) when retaining information at each interspace (“interspace-level analysis”), as compared to aggregating information across interspaces as is typically done in spine research (“person-level analysis”). The study compared results from (1) interspace-level analyses assuming a common relationship across interspaces (the “interspace-level, common-relationship” approach), (2) interspace-level analyses allowing for interspace-specific associations (an “interspace-level, interspace-specific” approach), (3) and a conventional person-level analytic approach. Methods: Adults in primary care (n = 147) received lumbar spine magnetic resonance imaging and neuroradiologist-evaluated assessments of prevalent disc height narrowing (DHN), type II MC, and other LDD parameters. Analyses examined associations between DHN and type II MC in interspace-level, common-relationship analyses, interspace-level, interspace-specific analyses, and conventional person-level analyses. Results: Cross-sectional, interspace-level, common-relationship analyses found large-magnitude DHN-type II MC associations (adjusted OR [aOR] = 6.5, 95% confidence intervals (CIs) 3.3–13; p < 0.001). The magnitude of this association was larger and more precise than that yielded by person-level analyses (aOR = 2.9 [95% CI 1.2–7]), and substantially more precise than interspace-level, interspace-specific analyses which allowed the association between DHN and type II MC to vary across levels. Across exploratory analyses of disc signal intensity and other MC types, interspace-level, common-relationship analyses produced larger-magnitude and more precise associations than person-level analyses in most situations, and were more precise than interspace-level, interspace-specific analyses. Conclusions: Interspace-level analytic approaches offer some advantages to person-level analyses that may be useful in understanding relationships between spinal degeneration findings.

AB - Purpose: To examine associations between lumbar intervertebral disc degeneration (LDD) and type II Modic changes (MC) when retaining information at each interspace (“interspace-level analysis”), as compared to aggregating information across interspaces as is typically done in spine research (“person-level analysis”). The study compared results from (1) interspace-level analyses assuming a common relationship across interspaces (the “interspace-level, common-relationship” approach), (2) interspace-level analyses allowing for interspace-specific associations (an “interspace-level, interspace-specific” approach), (3) and a conventional person-level analytic approach. Methods: Adults in primary care (n = 147) received lumbar spine magnetic resonance imaging and neuroradiologist-evaluated assessments of prevalent disc height narrowing (DHN), type II MC, and other LDD parameters. Analyses examined associations between DHN and type II MC in interspace-level, common-relationship analyses, interspace-level, interspace-specific analyses, and conventional person-level analyses. Results: Cross-sectional, interspace-level, common-relationship analyses found large-magnitude DHN-type II MC associations (adjusted OR [aOR] = 6.5, 95% confidence intervals (CIs) 3.3–13; p < 0.001). The magnitude of this association was larger and more precise than that yielded by person-level analyses (aOR = 2.9 [95% CI 1.2–7]), and substantially more precise than interspace-level, interspace-specific analyses which allowed the association between DHN and type II MC to vary across levels. Across exploratory analyses of disc signal intensity and other MC types, interspace-level, common-relationship analyses produced larger-magnitude and more precise associations than person-level analyses in most situations, and were more precise than interspace-level, interspace-specific analyses. Conclusions: Interspace-level analytic approaches offer some advantages to person-level analyses that may be useful in understanding relationships between spinal degeneration findings.

KW - Endplate

KW - Epidemiology

KW - Intervertebral disc

KW - Low back pain

KW - Lumbar spine

KW - Magnetic resonance imaging

UR - https://www.mendeley.com/catalogue/e19aa01f-6152-3534-b857-834b342b3b54/

UR - https://www.scopus.com/record/display.uri?eid=2-s2.0-105007822547&origin=inward&txGid=b88e5a96f44d95c5c809e21306971dfc

U2 - 10.1007/s00586-025-08976-w

DO - 10.1007/s00586-025-08976-w

M3 - Article

C2 - 40493208

JO - European Spine Journal

JF - European Spine Journal

SN - 0940-6719

ER -