Baseline MRI Characteristics in Asymptomatic Subjects as Predictors for Future First-Time LBP Episode

Abstract

Introduction Previously, it has been noted that there is no predictive value of MRI findings of degenerative changes of the lumbar spine in asymptomatic individuals in the development of first time episodes of low back pain (LBP). In a population-based cohort, this study addressed if radiographic findings on MRI in asymptomatic individuals are predictive in the development of first-time episodes of LBP and pain severity. Materials and Methods A prospective, radiographic and clinical study was performed in 248 asymptomatic individuals of Southern Chinese origin with no previous history of LBP. All subjects underwent sagittal MRI assessment of the lumbar spine. Assessment of disk degeneration was based on the Schneiderman et al radiographic criteria to determine the presence, extent, and severity of disk degeneration. A summated degenerative disk disease (DDD) score of the lumbar spine was obtained, representing the global severity of disk degeneration. The presence of disk bulge/extrusion, Schmorl's nodes (SN), and Modic changes were also noted. At 2 years minimum follow-up, clinical assessment was performed and subject demographics were noted to identify the development of LBP and functional outcome status (e.g., Oswestry disability index). Results There were 93 males and 155 females with a mean age at MRI of 42.9 years ( ± SD = 7.6, range: 21.1 to 54.6 years). Overall presence of disk degeneration, disk space narrowing, and disk bulge/extrusion was noted in 60.5, 19.0, and 34.3% of individuals, respectively. The mean DDD score was 2.2 ( ± SD = 2.9; range: 0 to 12). SN and Modic changes were noted in 10.5 and 1.2%, respectively. Clinical follow-up was performed at a mean of 4.3 years ( ± SD = 1.9, range: 2.2 to 10.0 years). The incidence rate of first-time LBP episodes on clinical follow-up was 34.7%. The mean age of first-time LBP episode was 44.8 years ( ± SD = 8.5; range: 22 to 57 years). Regression modeling noted that the presence of disk bulge/extrusion (OR: 2.37; 95% CI, 1.30–4.32) and increasing DDD score (>7 score OR: 6.90; 95% CI, 1.86–25.52), in particular if segments involved the mid lumbar region, demonstrated significant predictive utility for developing first-time LBP episode. DDD score and disk bulge/extrusion were found predictive to the severity of LBP, greater functional disability, and increased frequency of future LBP episodes (p < 0.05). Conclusion This large-scale prospective study substantiates that spinal changes are found in asymptomatic subjects on MRI; however, the “global severity” of disk degeneration on initial MRI may be predictive in the development of first-time LBP episodes. I confirm having declared any potential conflict of interest for all authors listed on this abstract No Disclosure of Interest None declared

Inhibiting tumor necrosis factor‐alpha at time of induced intervertebral disc injury limits long‐term pain and degeneration in a rat model

“…These results are consistent with another study that used an annular puncture model with NP removal that found a correlation between IVD degeneration and mechanical hyperalgesia, which was assayed directly on the low back . The multiple associations of pain with IVD structural and biochemical degenerative changes in this in vivo rat model have many similarities with painful IVD degeneration in humans, which supports the feasibility of using this rat model to understand the pathophysiology of discogenic pain . The lack of significant herniation or endplate damage in the observed IVD degeneration in this study is suggestive of intradiscal pro‐inflammatory cytokines as a cause for pain.…”

Disk Degeneration and Low Back Pain: Are They Fat-Related Conditions?

“…46 Samartzis et al have also noted that disk degeneration severity in asymptomatic individuals is predictive for future first-time LBP episodes. 47 These trends appear generalizable as Takatalo et al have noted for the Northern Finnish Birth Cohort that the severity of disk degeneration on MRI is associated with the severity of low back symptoms over a 3-year period in young adults. 18 What's more, a systematic review by Chou et al, addressing the association of disk degeneration on MRI and symptoms in various populations throughout the world, observed a significant association between disk degeneration and chronic LBP.…”

“…However, more recent studies based on large populations (over 2,500 Southern Chinese subjects) have shown that disk degeneration on MRI is significantly associated with LBP history in adults, and such an association increases according to the global severity of disk degeneration (i.e., degenerative disk disease score) 46. Samartzis et al have also noted that disk degeneration severity in asymptomatic individuals is predictive for future first-time LBP episodes 47. These trends appear generalizable as Takatalo et al have noted for the Northern Finnish Birth Cohort that the severity of disk degeneration on MRI is associated with the severity of low back symptoms over a 3-year period in young adults 18.…”

Novel diagnostic and prognostic methods for disc degeneration and low back pain

“…In fact, both global severity [10,11] and patterning [38] of lumbar DD are associated with increased risk of LBP. For example, a large-scale 4-year prospective study among asymptomatic Southern Chinese adults by Samartzis et al [39] has reported that baseline patterns of DD may predict future development of first-time LBP episodes. This indicates that although overall DD may not be synonymous with LBP, perhaps, specific degeneration patterns and severity may foretell a pain risk profile.…”