Abstract
Lumbar intervertebral disc degeneration (IVDD) is an important contributing factor for chronic low back pain. Recent evidence indicates that IVDD represents a “whole-organ” pathology involving multiple spinal structures, yet the relationships between structural magnetic resonance imaging (MRI) parameters remain incompletely characterised. This cross-sectional study included 100 patients with lumbar IVDD who underwent 3.0 T MRI. IVDD severity was graded using the Pfirrmann classification. Structural parameters including Modic changes, paraspinal muscle fat infiltration and facet joint degeneration were assessed independently by two radiologists. Statistical analyses included Spearman rank correlations, chi-square tests and logistic regression. Modic changes were present in 72% of patients and showed the strongest association with severe IVDD (Spearman r = 0.532, P < 0.001; χ2 = 20.446, P < 0.001). Patients with Modic changes had 6.11-fold higher odds [95% CI: 2.81–13.28] of severe disc degeneration compared to those without. The prevalence of severe IVDD increased progressively from 21.4% in Grade 0 to 76.9% in Grade 3 Modic changes. Facet joint degeneration, present in 92%, correlated significantly with IVDD grade (r = 0.259, P = 0.009; OR = 1.83, 95% CI: 1.15–2.91). Paraspinal muscle fat infiltration, present in 64%, showed a weak, non-significant association with IVDD severity (r = 0.167, P = 0.097). Lumbar IVDD represents a complex "whole-organ" condition. Modic changes showed the strongest structural association with severe disc degeneration (r = 0.532, OR = 6.11), supporting a strong coupling between disc degeneration and endplate pathology. These findings reinforce the "three-joint complex" concept and have implications for comprehensive treatment strategies targeting multiple spinal structures.
Keywords: Facet Joint Degeneration, Intervertebral Disc Degeneration, Lumbar Spine, Magnetic Resonance Imaging, Modic Changes.