EBQ:Twin Spine Study

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Study: Battié et al.. The Twin Spine Study: contributions to a changing view of disc degeneration. The spine journal : official journal of the North American Spine Society 2009. 9:47-59. PMID: 19111259. DOI. Full Text

Clinical Question

What is the contribution of genetics to disc degeneration?

Bottom Line

There is a substantial influence of heredity on lumbar disc degeneration. There is little effect on disc degeneration from occupational and leisure-time physical loading, and increased loading may have a small benefit. There is only a small effect from smoking. Body weight and muscle strength have modest effects on disc degeneration. Some candidate genes were identified.

Study Design

The Twin Spine Study, which started in 1991, is a multidisciplinary, multinational research project with collaborators primarily in Canada, Finland, and the United States. They investigated occupational exposures, driving and whole-body vibration exposure, smoking exposure, anthropomorphic factors, heritability, and the identification of genotypes associated with disc degeneration.

Population Studied

Inclusion Criteria

Exclusion Criteria

Baseline Characteristics



Primary Outcomes

  • T12–L4 region: 61% of the variance in disc degeneration was explained by familial aggregation, beyond that of age and occupational physical loading that together explained 16%.
  • L4–S1 discs: 11% of disc degeneration was explained by physical loading and age, which rose to 43% once familial aggregation was added to the model. In contrast to the upper lumbar levels, 57% remained unexplained in the lower lumbar region

The variability (adj. R2) in qualitative disc degeneration summary scores explained by physical loading, age, and familial aggregation (proxy of heredity) demonstrated that significantly more variability remained unexplained in the L4–S1 disc levels.

Secondary Outcomes

Adverse events




See Also