An Analysis of Hypermobility and Degenerative Disc Disease Using the COSMOS Database

Introduction: Patients with connective tissue disease, such as Ehlers-Danlos Syndrome (EDS), often have a wide range of symptoms across organ systems. In particular, intervertebral disks are complex cartilaginous structures similar to other connective tissues. This indicates a possible relationship between disk diseases and connective diseases. Degenerative disk disease (DDD) is of particular interest due to the prevalence and pathophysiology of this disease.

Methods: The COSMOS national database was utilized in this study to explore the demographic differences between patients with hypermobility and DDD and patients with DDD without hypermobility. A retrospective review was completed and chi-squared tests were performed to analyze differences between these groups.

Results: Out of 160,215 reported hypermobile patients, 11,954 (7.5%) had a concurrent diagnosis of DDD compared to 2.1% of non-hypermobile patients (p-value < 0.05). 65.3% of the DDD cases in the hypermobile group were diagnosed before the age of 54 while only 23.3% were diagnosed in this age range for the control group (p-value < 0.05). Cervical degeneration made up 34.7% of the hypermobile cases compared to 27.5% of the non-hypermobile group (p-value < 0.05). There was not a significant difference in the proportion of patients that underwent surgery for DDD treatment between these groups.

Conclusion : A larger proportion of hypermobile patients had a diagnosis of DDD compared to healthy control. The hypermobile patients were diagnosed at an earlier age, possibly due to further degeneration earlier on or more severe symptoms. These patients were more likely to develop degeneration in the cervical spine. This could be due to a biomechanical influence on the development of DDD in hypermobile patients that should be explored in future research.