Date of Conferral



Doctor of Public Health (DrPH)


Public Health


Joseph F. Robare


Low back pain has a significant impact on global public health and economics. The bright facet sign (BFS), a common finding on magnetic resonance imaging (MRI) of the lumbar spine, is associated with low back pain. While degenerative joint disease (DJD) affects low back pain, its presence appears independent of the BFS at the disc and facet joints at the same spinal level. Increased BMI, considered a risk factor for DJD, has an inverse association with the BFS. The independent relationship of DJD and the BFS is poorly understood and may represent a previously unreported pain pathway. In this nested case-control quantitative study, based on an accepted conceptual framework, 350 lumbar MRI studies on symptomatic patients with historic and anthropomorphic data related to low back pain were analyzed using Spearman's Rho and Multivariate Logistic Regression to examine any associations between the BFS at 3 spinal levels and the independent variables age, race/ethnicity, physical activity, BMI, trauma, low back pain, and DJD. The findings revealed significant associations between the BFS and the duration of pain, age, and gender at 1 or more spinal levels, the BFS and BMI and degenerative facet disease (DFD) at all 3 spinal levels, and no association between the BFS and degenerative disc disease (DDD). These results, contrary to current medical constructs where BMI, DFD, and DDD are considered predictive of low back pain, facilitate an improved understanding of joint function and contribute to the current body of knowledge related to low back pain. An understanding of the BFS as it relates to DJD and low back pain will assist clinicians with the early detection of spinal degeneration and the mitigation of pain and suffering, contributing to positive social change.

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