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Scientific Articles   |    
Evidence for an Inherited Predisposition to Lumbar Disc Disease
Alpesh A. Patel, MD1; William Ryan Spiker, MD1; Michael Daubs, MD1; Darrel Brodke, MD1; Lisa A. Cannon-Albright, PhD2
1 Department of Orthopaedics, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address for A.A. Patel: Alpesh.Patel@hsc.utah.edu. E-mail address for W.R. Spiker: Ryan.Spiker@hsc.utah.edu. E-mail address for M. Daubs: Michael.Daubs@hsc.utah.edu. E-mail address for D. Brodke: Darrel.Brodke@hsc.utah.edu
2 Genetic Epidemiology, Department of Biomedical Informatics, University of Utah School of Medicine, 26 South 2000 East, Room 5775 HSEB, Salt Lake City, UT 84112. E-mail address: lisa.albright@utah.edu
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Institutes of Health-National Library of Medicine (LM009331). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Departments of Orthopaedics and Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah
A commentary by David A. Wong, MD, MSc, FRCS(C), is available at www.jbjs.org/commentary and is linked to the online version of this article.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Feb 02;93(3):225-229. doi: 10.2106/JBJS.J.00276
A commentary by David A. Wong, MD, MSc, FRCS(C), is available here
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Abstract

Background: 

A genetic predisposition for the development of symptomatic lumbar disc disease has been suggested by several twin sibling studies and subsequent genetic marker studies. The purpose of the present study was to define population-based familial clustering among individuals with a diagnosis of, or treated for, lumbar disc herniation or disc degeneration.

Methods: 

The Utah Population Database allows analysis of combined health and genealogic data for over one million Utah residents. We used the International Classification of Diseases, Ninth Revision, diagnosis codes entered in patient records to identify patients with a diagnosis of either lumbar disc herniation or lumbar disc degeneration and genealogic data. The hypothesis of excess relatedness (familial clustering) was tested with use of the Genealogical Index of Familiality, which compares the average relatedness of affected individuals with expected population relatedness. Relative risks in relatives were estimated by comparing rates of disease in relatives with expected population rates (estimated from the relatives of matched controls). This methodology has been previously reported for other disease conditions but not for spinal diseases.

Results: 

The Genealogical Index of Familiality test for 1264 patients with lumbar disc disease showed a significant excess relatedness (p < 0.001). Relative risk in relatives was significantly elevated in both first-degree (relative risk, 4.15; p < 0.001) and third-degree relatives (relative risk, 1.46; p = 0.027).

Conclusions: 

Excess relatedness of affected individuals and elevated risks to both near and distant relatives was observed, strongly supporting a heritable contribution to the development of symptomatic lumbar disc disease.

Level of Evidence: 

Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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