Advantages to interspace-level analyses over person-level analyses when studying relationships between lumbar spinal degeneration findings: a cross-sectional study

PurposeTo 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), and (3) a conventional person-level analytic approach. MethodsAdults in primary care (n=147) received lumbar spine magnetic resonance imaging (MRI) 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, commonrelationship analyses, interspace-level, interspace-specific analyses, and conventional person-level analyses. ResultsCross-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. ConclusionsInterspace-level analytic approaches offer some advantages to person-level analyses that may be useful in understanding relationships between spinal degeneration findings.