MRI findings are more common in selected patients with acute low back pain than controls?

Abstract

Purpose The purpose of this study is to investigate if lumbar disc pathology identified on MRI scans is more common in patients with acute, likely discogenic, low back pain than matched controls. Methods We compared rates of MRI findings between 30 cases with low back pain and 30 pain-free controls. Cases were patients presenting for care with likely discogenic low back pain (demonstrated centralisation with repeated movement testing), of moderate intensity and with minimal past history of back pain. Controls were matched for age, gender and past history of back pain. Cases and controls underwent MRI scanning which was read for the presence of a range of MRI findings by two blinded assessors. ResultsThe presence of disc degeneration, modic changes and disc herniation significantly altered the odds of a participant being a case or control. For example subjects were 5.2 times more likely to be a case than a control when disc degeneration grade of C3 was present, and 6.0 times more likely with modic changes. The presence of a high-intensity zone or annular tear was found to significantly alter odds for one assessor but not the other assessor. Conclusion MRI findings including disc degeneration, modic changes and herniation are more common in selected people with current acute (likely discogenic) low back pain than in controls without current low back pain. Further investigation of the value of MRI findings as prognostic factors and as treatment effect modifiers is required to assess the potential clinical importance of these findings.

MRI histogram analysis enables objective and continuous classification of intervertebral disc degeneration

“…The associated direct and indirect annual total costs for back pain are estimated to 1-2% of GDP [3,4]. Degeneration of intervertebral discs (IVDs) is strongly associated with LBP and suggested to be the most common cause of LBP [5][6][7].…”

Evaluation of intramyocellular and extramyocellular lipids in the paraspinal muscle in patients with chronic low back pain using MR spectroscopy: preliminary results

“…and non-specific pain, in which the source is difficult to identify. Nonspecific LBP, which comprises $80% of all cases, [5][6][7] can be further classified into myofascial, discogenic, facet-related and sacroiliac joint-related LBP. 5 Although various diagnostic imaging modalities and auxiliary methods are used, the cause of chronic low back pain (CLBP) can rarely be clarified in individual patients.…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review

“…This paper and the one alluded to above by Djurasovic et al [16] indicate that the value and significance of Modic changes are not fully understood particularly in chronic low back pain. However, the paper by Hancock et al [23] does confirm that MRI findings were five times more common in selected patients with acute back pain than controls without back pain. The value of this paper is that the patient group was selected carefully to ensure that the likely source of the pain was discogenic, the pain was acute and it responded to centralization manoeuvres, generally accepted as being most typical of discogenic pain.…”