Lumbar subcutaneous edema and degenerative spinal disease in patients with low back pain: a retrospective MRI study

Abstract

LSE is highly associated with spondylolisthesis, facet arthropathy and BMI, suggesting underestimation of its clinical impact as an integral component in chronic lumbar back pain. Longitudinal simultaneous X-ray/MRI studies should be conducted to test the relationship of LSE with lumbar spinal instability and low back pain.

When an incidental MRI finding becomes a clinical issue

“…For the vast majority, there was a statistically significant relationship between PLSE and its extent and the patients' BMI. Because of this relationship, which has also been demonstrated in previous studies, several authors have formulated hypotheses to provide explanations for the occurrence of PLSE in obesity [1,[4][5][6][7][8][9][10]. This includes various cascades of pathophysiological changes on a macrovascular, microvascular, hormonal, and molecular levels [1,[4][5][6][7][8][9][10].…”

“…The whole image stack of the sagittal STIR sequence was used to confirm or to rule out the presence of PLSE, which was defined as diffuse STIR-hyperintense signal changes within the deep posterior lumbar subcutaneous tissue that did not reach the superficial fat layers [1,2,[4][5][6][7][8][9][10][11]. PLSE was also defined by its location along the fascia plane next to the thoracolumbar fascia and posterior to the spinous process, at the midline, and extending laterally [1,2,[4][5][6][7][8][9][10][11]. Any edema was graded according to its craniocaudal extension with respect to the vertebral bodies from 1-5 (i.e., from one to five vertebral levels), and was consequently classified as monosegmental, one vertebral level, or multisegmental, two or more vertebral levels ( Fig.…”

“…This includes various cascades of pathophysiological changes on a macrovascular, microvascular, hormonal, and molecular levels [1,[4][5][6][7][8][9][10]. It has been also hypothesized that lumbar degeneration and low back pain may be associated with a decrease in venous and lymphatic drainage from soft tissues due to the restriction of physical activity [9]. This consideration was supported by the finding that PLSE was particularly seen in hospitalized patients with prolonged bed rest [4].…”

“…On MRI, PLSE is best observed on a sagittal midline view within the deep-fat tissue along the thoracolumbar fascia, covering a triangle-shaped area on transverse images [1,7,9,10]. The MRI findings of PLSE seem to mimic a peritendinitis-like appearance, potentially suggesting abnormal stress and overuse of the fascial tissues.…”

“…These data confirm the anecdotal radiological experience that PLSE is commonly encountered in obese patients. The presence of PLSE seems to be associated with low back pain and posterior lumbar compartment degeneration, but has been found in asymptomatic, yet degeneratively changed subjects as well [9][10][11].…”