{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T17:06:11Z","timestamp":1784135171892,"version":"3.55.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006196","name":"University of Oulu","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006196","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Spine J"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The temporal sequence of lumbar spine degeneration (trajectory) is difficult to characterize due to limited availability of longitudinal imaging data. The aim of this cross-sectional study was to discover degeneration trajectories and their clinical relevance by applying an innovative computational approach to an extensive dataset from chronic low back pain patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical MRI exams from 423 patients in the comeBACK study were graded for disc degeneration, facet osteoarthritis, and other pathoanatomical features. We then trained an event-based model, which is specifically designed to infer longitudinal trajectories from cross-sectional data, to model spine degeneration trajectory subtypes. The clinical significance of the identified trajectories was assessed using propensity score matching of trajectory subtypes and subsequent generalized linear mixed-effects modeling. Pain characteristics included the Fear-Avoidance Beliefs Questionnaire, neuropathic pain (painDETECT), pain impact score, and chronic widespread pain (CWP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Two distinct trajectories were identified. A \u201cdisc-first\u201d subtype (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009260, 61%) was characterized by a high prevalence of disc herniation and disc degeneration that was more severe than facet osteoarthritis. Conversely, a \u201cfacet-first\u201d subtype (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009146, 39%) was characterized by a greater severity of facet osteoarthritis than disc degeneration. The disc-first subtype was associated with more CWP (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.030), while the facet-first subtype had higher neuropathic pain (painDETECT scores) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.039).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We identified two distinct trajectories of lumbar spine degeneration related to differing clinical presentations. After replication with other large datasets, this method could be used to characterize and stage spinal degeneration of individual patients. Ultimately, this new information would help clarify degeneration mechanisms and risk factors and support treatment optimization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00586-026-09840-1","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T06:11:45Z","timestamp":1772259105000},"page":"3695-3707","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["ISSLS Prize in Clinical Science 2026: Data-driven classification of lumbar spine degeneration trajectories in chronic low back pain"],"prefix":"10.1007","volume":"35","author":[{"given":"Terence P.","family":"McSweeney","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zehra","family":"Akkaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiamin","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Hung","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah B.","family":"Bonnheim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M.","family":"Link","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaro","family":"Karppinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey C.","family":"Lotz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simo","family":"Saarakkala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron J.","family":"Fields","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksei","family":"Tiulpin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"9840_CR1","doi-asserted-by":"publisher","first-page":"1484","DOI":"10.1097\/brs.0b013e3181753bb1","volume":"33","author":"T Videman","year":"2008","unstructured":"Videman T, Batti\u00e9 MC, Parent E, Gibbons LE, Vainio P, Kaprio J (2008) Progression and determinants of quantitative magnetic resonance imaging measures of lumbar disc degeneration. Spine 33:1484\u20131490. https:\/\/doi.org\/10.1097\/brs.0b013e3181753bb1","journal-title":"Spine"},{"key":"9840_CR2","doi-asserted-by":"publisher","first-page":"3112","DOI":"10.1002\/art.11321","volume":"48","author":"G Hassett","year":"2003","unstructured":"Hassett G, Hart DJ, Manek NJ, Doyle DV, Spector TD (2003) Risk factors for progression of lumbar spine disc degeneration: the Chingford Study. Arthritis Rheum 48:3112\u20133117. https:\/\/doi.org\/10.1002\/art.11321","journal-title":"Arthritis Rheum"},{"key":"9840_CR3","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-023-07542-6","author":"NB Bonnheim","year":"2023","unstructured":"Bonnheim NB, Lazar AA, Kumar A et al (2023) ISSLS prize in bioengineering science 2023: age- and sex-related differences in lumbar intervertebral disc degeneration between patients with chronic low back pain and asymptomatic controls. Eur Spine J. https:\/\/doi.org\/10.1007\/s00586-023-07542-6","journal-title":"Eur Spine J"},{"key":"9840_CR4","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1007\/s00586-022-07184-0","volume":"31","author":"A Aavikko","year":"2022","unstructured":"Aavikko A, Lohman M, Ristolainen L, Kautiainen H, \u00d6sterman K, Schlenzka D, Lund T (2022) ISSLS prize in clinical science 2022: accelerated disc degeneration after pubertal growth spurt differentiates adults with low back pain from their asymptomatic peers. Eur Spine J 31:1080\u20131087. https:\/\/doi.org\/10.1007\/s00586-022-07184-0","journal-title":"Eur Spine J"},{"key":"9840_CR5","doi-asserted-by":"publisher","DOI":"10.1002\/jsp2.1063","volume":"2","author":"CME Rustenburg","year":"2019","unstructured":"Rustenburg CME, Faraj SSA, Ket JCF, Emanuel KS, Smit TH (2019) Prognostic factors in the progression of intervertebral disc degeneration: which patient should be targeted with regenerative therapies? Jor Spine 2:e1063. https:\/\/doi.org\/10.1002\/jsp2.1063","journal-title":"Jor Spine"},{"key":"9840_CR6","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1136\/ard.2010.146001","volume":"70","author":"FMK Williams","year":"2011","unstructured":"Williams FMK, Popham M, Sambrook PN, Jones AF, Spector TD, MacGregor AJ (2011) Progression of lumbar disc degeneration over a decade: a heritability study. Ann Rheum Dis 70:1203. https:\/\/doi.org\/10.1136\/ard.2010.146001","journal-title":"Ann Rheum Dis"},{"key":"9840_CR7","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2025.103446","volume":"81","author":"L Dragsb\u00e6k","year":"2026","unstructured":"Dragsb\u00e6k L, Kj\u00e6r P, Jensen RK, Hancock M, Luca K, Jensen TS (2026) How to summarise or combine lumbar MRI-findings for studying associations with low back pain: a modified Delphi study. Musculoskelet Sci Pract 81:103446. https:\/\/doi.org\/10.1016\/j.msksp.2025.103446","journal-title":"Musculoskelet Sci Pract"},{"key":"9840_CR8","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1016\/j.jos.2017.03.015","volume":"22","author":"H Makino","year":"2017","unstructured":"Makino H, Kawaguchi Y, Seki S, Nakano M, Yasuda T, Suzuki K, Ikegawa S, Kimura T (2017) Lumbar disc degeneration progression in young women in their 20\u2019s: a prospective ten-year follow up. J Orthop Sci 22:635\u2013640. https:\/\/doi.org\/10.1016\/j.jos.2017.03.015","journal-title":"J Orthop Sci"},{"key":"9840_CR9","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1016\/j.spinee.2013.11.018","volume":"14","author":"T Videman","year":"2014","unstructured":"Videman T, Batti\u00e9 MC, Gibbons LE, Gill K (2014) Aging changes in lumbar discs and vertebrae and their interaction: a 15-year follow-up study. Spine J 14:469\u2013478. https:\/\/doi.org\/10.1016\/j.spinee.2013.11.018","journal-title":"Spine J"},{"key":"9840_CR10","doi-asserted-by":"publisher","first-page":"2065","DOI":"10.1016\/j.spinee.2018.04.010","volume":"18","author":"M Jarraya","year":"2018","unstructured":"Jarraya M, Guermazi A, Lorbergs AL, Brochin E, Kiel DP, Bouxsein ML, Cupples LA, Samelson EJ (2018) A longitudinal study of disc height narrowing and facet joint osteoarthritis at the thoracic and lumbar spine, evaluated by computed tomography: the Framingham Study. Spine J 18:2065\u20132073. https:\/\/doi.org\/10.1016\/j.spinee.2018.04.010","journal-title":"Spine J"},{"key":"9840_CR11","doi-asserted-by":"publisher","first-page":"2350","DOI":"10.1007\/s00586-023-07544-4","volume":"32","author":"M Moser","year":"2023","unstructured":"Moser M, Amini DA, Sanchez LA et al (2023) The association between vertebral endplate defects, subchondral bone marrow changes, and lumbar intervertebral disc degeneration: a retrospective, 3-year longitudinal study. Eur Spine J 32:2350\u20132357. https:\/\/doi.org\/10.1007\/s00586-023-07544-4","journal-title":"Eur Spine J"},{"key":"9840_CR12","doi-asserted-by":"publisher","first-page":"2742","DOI":"10.1097\/01.brs.0000146498.04628.f9","volume":"29","author":"JC Lotz","year":"2004","unstructured":"Lotz JC (2004) Animal models of intervertebral disc degeneration. Spine 29:2742\u20132750. https:\/\/doi.org\/10.1097\/01.brs.0000146498.04628.f9","journal-title":"Spine"},{"key":"9840_CR13","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1016\/j.spinee.2016.04.020","volume":"16","author":"Y Li","year":"2016","unstructured":"Li Y, Samartzis D, Campbell DD et al (2016) Two subtypes of intervertebral disc degeneration distinguished by large-scale population-based study. Spine J 16:1079\u20131089. https:\/\/doi.org\/10.1016\/j.spinee.2016.04.020","journal-title":"Spine J"},{"key":"9840_CR14","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1016\/j.neuroimage.2018.11.024","volume":"186","author":"V Venkatraghavan","year":"2019","unstructured":"Venkatraghavan V, Bron EE, Niessen WJ, Klein S, Initiative for the ADN (2019) Disease progression timeline estimation for Alzheimer\u2019s disease using discriminative event based modeling. Neuroimage 186:518\u2013532. https:\/\/doi.org\/10.1016\/j.neuroimage.2018.11.024","journal-title":"Neuroimage"},{"key":"9840_CR15","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2021.726140","volume":"9","author":"M Li","year":"2021","unstructured":"Li M, Lan L, Luo J, Peng L, Li X, Zhou X (2021) Identifying the phenotypic and temporal heterogeneity of knee osteoarthritis: data from the Osteoarthritis Initiative. Front Public Health 9:726140. https:\/\/doi.org\/10.3389\/fpubh.2021.726140","journal-title":"Front Public Health"},{"key":"9840_CR16","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-018-05892-0","volume":"9","author":"AL Young","year":"2018","unstructured":"Young AL, Marinescu RV, Oxtoby NP et al (2018) Uncovering the heterogeneity and temporal complexity of neurodegenerative diseases with subtype and stage inference. Nat Commun 9:4273. https:\/\/doi.org\/10.1038\/s41467-018-05892-0","journal-title":"Nat Commun"},{"key":"9840_CR17","doi-asserted-by":"publisher","unstructured":"Hue TF, Lotz JC, Zheng P et al (2024) Design of the COMEBACK and BACKHOME Studies, Longitudinal Cohorts for Comprehensive Deep Phenotyping of Adults with Chronic Low-Back Pain (cLBP): a part of the BACPAC Research Program. medRxiv 2024.04.09.24305574 https:\/\/doi.org\/10.1101\/2024.04.09.24305574","DOI":"10.1101\/2024.04.09.24305574"},{"key":"9840_CR18","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/j.jpain.2014.03.005","volume":"15","author":"RA Deyo","year":"2014","unstructured":"Deyo RA, Dworkin SF, Amtmann D et al (2014) Report of the NI H task force on research standards for chronic low back pain. J Pain 15:569\u201385. https:\/\/doi.org\/10.1016\/j.jpain.2014.03.005","journal-title":"J Pain"},{"key":"9840_CR19","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1093\/pm\/pnac202","volume":"24","author":"MC Mauck","year":"2023","unstructured":"Mauck MC, Lotz J, Psioda MA et al (2023) The back pain consortium (BACPAC) research program: structure, research priorities, and methods. Pain Med 24:S3\u2013S12. https:\/\/doi.org\/10.1093\/pm\/pnac202","journal-title":"Pain Med"},{"key":"9840_CR20","doi-asserted-by":"publisher","first-page":"S81","DOI":"10.1093\/pm\/pnac130","volume":"24","author":"N Sollmann","year":"2022","unstructured":"Sollmann N, Fields AJ, O\u2019Neill C et al (2022) Magnetic resonance imaging of the lumbar spine: recommendations for acquisition and image evaluation from the BACPAC spine imaging working group. Pain Med 24:S81\u2013S94. https:\/\/doi.org\/10.1093\/pm\/pnac130","journal-title":"Pain Med"},{"issue":"7","key":"9840_CR21","doi-asserted-by":"publisher","first-page":"E430","DOI":"10.1097\/brs.0b013e3182304dfc","volume":"37","author":"KMC Cheung","year":"2012","unstructured":"Cheung KMC, Samartzis D, Karppinen J, Luk KDK (2012) Are patterns of lumbar disc degeneration associated with low back pain? Spine 37(7):E430\u2013E438. https:\/\/doi.org\/10.1097\/brs.0b013e3182304dfc","journal-title":"Spine"},{"key":"9840_CR22","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1097\/00007632-200109010-00011","volume":"26","author":"CWA Pfirrmann","year":"2001","unstructured":"Pfirrmann CWA, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 26:1873\u20131878. https:\/\/doi.org\/10.1097\/00007632-200109010-00011","journal-title":"Spine"},{"key":"9840_CR23","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/s002560050503","volume":"28","author":"D Weishaupt","year":"1999","unstructured":"Weishaupt D, Zanetti M, Boos N, Hodler J (1999) MR imaging and CT in osteoarthritis of the lumbar facet joints. Skelet Radiol 28:215\u2013219. https:\/\/doi.org\/10.1007\/s002560050503","journal-title":"Skelet Radiol"},{"key":"9840_CR24","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1148\/radiology.166.1.3336678","volume":"166","author":"MT Modic","year":"1988","unstructured":"Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166:193\u2013199. https:\/\/doi.org\/10.1148\/radiology.166.1.3336678","journal-title":"Radiology"},{"key":"9840_CR25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v067.i01","volume":"67","author":"D Bates","year":"2015","unstructured":"Bates D, M\u00e4chler M, Bolker B, Walker S (2015) Fitting linear mixed-effects models using lme4. J Stat Softw 67:1\u201348. https:\/\/doi.org\/10.18637\/jss.v067.i01","journal-title":"J Stat Softw"},{"key":"9840_CR26","doi-asserted-by":"publisher","first-page":"1316","DOI":"10.1097\/00007632-199907010-00008","volume":"24","author":"JJ Salminen","year":"1999","unstructured":"Salminen JJ, Erkintalo MO, Pentti J, Oksanen A, Kormano MJ (1999) Recurrent low back pain and early disc degeneration in the young. Spine 24:1316. https:\/\/doi.org\/10.1097\/00007632-199907010-00008","journal-title":"Spine"},{"key":"9840_CR27","doi-asserted-by":"publisher","first-page":"1465","DOI":"10.1007\/s00586-024-08156-2","volume":"33","author":"S Sima","year":"2024","unstructured":"Sima S, Lapkin S, Diwan AD (2024) In subjects with chronic low back pain, does neuropathia exclusively correlated to neuronal compression? A correlation study of PainDETECT questionnaire and corresponding MRI and X-ray findings. Eur Spine J 33:1465\u20131473. https:\/\/doi.org\/10.1007\/s00586-024-08156-2","journal-title":"Eur Spine J"},{"key":"9840_CR28","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1111\/j.1469-7580.2012.01551.x","volume":"221","author":"MA Adams","year":"2012","unstructured":"Adams MA, Dolan P (2012) Intervertebral disc degeneration: evidence for two distinct phenotypes. J Anat 221:497\u2013506. https:\/\/doi.org\/10.1111\/j.1469-7580.2012.01551.x","journal-title":"J Anat"},{"issue":"3","key":"9840_CR29","doi-asserted-by":"publisher","DOI":"10.1093\/braincomms\/fcac098","volume":"4","author":"WJ Scotton","year":"2022","unstructured":"Scotton WJ, Bocchetta M, Todd E, Cash DM, Oxtoby N, VandeVrede L et al (2022) A data-driven model of brain volume changes in progressive supranuclear palsy. Brain Commun 4(3):fcac098. https:\/\/doi.org\/10.1093\/braincomms\/fcac098","journal-title":"Brain Commun"}],"updated-by":[{"DOI":"10.1007\/s00586-026-10149-2","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000}}],"container-title":["European Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-026-09840-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00586-026-09840-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-026-09840-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T16:28:50Z","timestamp":1784132930000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00586-026-09840-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,28]]},"references-count":29,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["9840"],"URL":"https:\/\/doi.org\/10.1007\/s00586-026-09840-1","relation":{},"ISSN":["0940-6719","1432-0932"],"issn-type":[{"value":"0940-6719","type":"print"},{"value":"1432-0932","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,28]]},"assertion":[{"value":"15 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 February 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 February 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 July 2026","order":6,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":7,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":8,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1007\/s00586-026-10149-2","URL":"https:\/\/doi.org\/10.1007\/s00586-026-10149-2","order":9,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}