Lumbar intervertebral disc degeneration, end-plates and paraspinal muscle changes in children and adolescents with low-back pain

Abstract

The prevalence of low-back pain (LBP) in adolescents ranges from 7 to 72%. We aimed to define the radiologic characteristics of the lumbar spine in children and adolescents with LBP with/without leg pain. Two hundred and fourteen children and adolescents, who were born between 2001 and 2009 and had lumbar spine MRI for LBP with/without leg pain, were evaluated in terms of intervertebral disc degeneration (IVDD), end-plates and paraspinal muscle changes on lumbar spine MRIs. Severe IVDD was detected at all lumbar levels except for L2-L3. Modic changes were present in 4.2% of the patients. Modic changes were more common in patients with severe IVDD than in those with mild-to-moderate IVDD.Severe IVDD was significantly associated with Modic changes at the corresponding L1-L2 and L3-L4 disc levels. Girls had significantly more fatty infiltration in the paraspinal muscles when compared to boys. The risk of having severe IVDD concomitant with Modic changes was high [odds ratio (OR), 8.6]. The OR was 20.7 for predicting the presence of severe IVDD at any level if Modic changes presented particularly at the L3-L4 level. The ORs of Modic changes presented at any lumbar level at the background of fat-infiltrated multifidus at L3-L4 and L4-L5 levels were 8.3 and 9.1, respectively. Fatty infiltration in the paraspinal muscles and IVDD were closely associated with Modic changes in children and adolescents with LBP. Lumbar IVDD in children and adolescents could be the result of a mechanical pathology.

Automatic detection and voxel‐wise mapping of lumbar spine Modic changes with deep learning

“…This is particularly important when considering intervertebral disc degeneration due to the strong correlation between presence of the two anomalies. 31 , 32 The performance of this model is consistent with previous works in spinal segmentation 21 , 23 and conveys to users of this tool which regions were evaluated by the subsequent Modic detection tool. Similarly, the rule‐based classification system proposed here, based on T 1 and T 2 z ‐scores, intuitively follows the semiquantitative blueprint originally proposed by Modic et al 8 Ultimately, the availability of intermediary results and interfaces for the pipeline's decision‐making process may build confidence toward the adoption of such methodologies into clinical settings.…”

“…To limit the effective field‐of‐view to regions of the vertebral bone, rather than confounding structures such as the neighboring intervertebral discs, foramen, or spinal cord, we performed vertebral body segmentation using the V‐Net, 30 a widely used encoder‐decoder for biomedical image segmentation. This is particularly important when considering intervertebral disc degeneration due to the strong correlation between presence of the two anomalies 31,32 . The performance of this model is consistent with previous works in spinal segmentation 21,23 and conveys to users of this tool which regions were evaluated by the subsequent Modic detection tool.…”

The relationships between physical activity, lumbar multifidus muscle morphology, and low back pain from childhood to early adulthood: a 12-year longitudinal study

“…Currently, the antecedents of lumbar multifidus IMAT infiltration remain poorly understood and this will be an important topic for future study. Preliminary evidence suggests that lumbar multifidus degeneration may result from mechanical pathology 25 or degeneration-induced inflammatory changes of the muscle 26 . A better understanding of the mechanisms responsible for muscle degeneration may help to guide future research efforts.…”

Correlation between the fatty infiltration of paraspinal muscles and disc degeneration and the underlying mechanism

“…Unfortunately, the pathological mechanisms of LDD have not been completely understood. Recently, several studies have focused on fatty infiltration of paraspinal muscles in LDD [ 4 – 7 ].…”