Prognostic Factors of Prolonged Disability in Patients With Chronic Low Back Pain and Lumbar Degeneration in Primary Care

Wilkens, Philip; Scheel, Inger B.; Grundnes, Oliver; Hellum, Christian; Storheim, Kjersti

doi:10.1097/brs.0b013e318263bb7b

Cited by 51 publications

(27 citation statements)

References 72 publications

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“…Nevertheless, the current literature about the association of Modic changes and low back pain (as well as the predictive value of Modic changes upon surgical outcomes after lumbar fusion) is still very controversial, with several studies suggesting that no meaningful association exists [55].…”

Section: Discussionmentioning

confidence: 99%

The ‘Lumbar Fusion Outcome Score’ (LUFOS): a new practical and surgically oriented grading system for preoperative prediction of surgical outcomes after lumbar spinal fusion in patients with degenerative disc disease and refractory chronic axial low back pain

Mattei¹,

Rehman

Teles

et al. 2016

Neurosurg Rev

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In order to evaluate the predictive effect of non-invasive preoperative imaging methods on surgical outcomes of lumbar fusion for patients with degenerative disc disease (DDD) and refractory chronic axial low back pain (LBP), the authors conducted a retrospective review of 45 patients with DDD and refractory LBP submitted to anterior lumbar interbody fusion (ALIF) at a single center from 2007 to 2010. Surgical outcomes - as measured by Visual Analog Scale (VAS/back pain) and Oswestry Disability Index (ODI) - were evaluated pre-operatively and at 6 weeks, 3 months, 6 months, and 1 year post-operatively. Linear mixed-effects models were generated in order to identify possible preoperative imaging characteristics (including bone scan/99mTc scintigraphy increased endplate uptake, Modic endplate changes, and disc degeneration graded according to Pfirrmann classification) which may be predictive of long-term surgical outcomes . After controlling for confounders, a combined score, the Lumbar Fusion Outcome Score (LUFOS), was developed. The LUFOS grading system was able to stratify patients in two general groups (Non-surgical: LUFOS 0 and 1; Surgical: LUFOS 2 and 3) that presented significantly different surgical outcomes in terms of estimated marginal means of VAS/back pain (p = 0.001) and ODI (p = 0.006) beginning at 3 months and continuing up to 1 year of follow-up. In conclusion, LUFOS has been devised as a new practical and surgically oriented grading system based on simple key parameters from non-invasive preoperative imaging exams (magnetic resonance imaging/MRI and bone scan/99mTc scintigraphy) which has been shown to be highly predictive of surgical outcomes of patients undergoing lumbar fusion for treatment for refractory chronic axial LBP.

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Section: Discussionmentioning

confidence: 99%

The ‘Lumbar Fusion Outcome Score’ (LUFOS): a new practical and surgically oriented grading system for preoperative prediction of surgical outcomes after lumbar spinal fusion in patients with degenerative disc disease and refractory chronic axial low back pain

Mattei¹,

Rehman

Teles

et al. 2016

Neurosurg Rev

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“…[12][13][14] The association between longer duration of pain and poorer prognosis is consistent with the findings in cohort studies that greater disease burden in general (eg, higher baseline pain scores and disability) predicts poorer outcomes for spinal pain. [15][16][17] Neck pain can also be categorized by mechanisms as mechanical, neuropathic, or secondary to another cause (eg, referred pain from the heart or vascular pathology). Mechanical pain refers to pain originating in the spine or its supporting structures, such as ligaments and muscles.…”

Section: Classification Of Neck Painmentioning

confidence: 99%

Epidemiology, Diagnosis, and Treatment of Neck Pain

Cohen

2015

Mayo Clinic Proceedings

503

303

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Neck pain is the fourth leading cause of disability, with an annual prevalence rate exceeding 30%. Most episodes of acute neck pain will resolve with or without treatment, but nearly 50% of individuals will continue to experience some degree of pain or frequent occurrences. History and physical examination can provide important clues as to whether the pain is neuropathic or mechanical and can also be used to identify "red flags" that may signify serious pathology, such as myelopathy, atlantoaxial subluxation, and metastases. Magnetic resonance imaging is characterized by a high prevalence of abnormal findings in asymptomatic individuals but should be considered for cases involving focal neurologic symptoms, pain refractory to conventional treatment, and when referring a patient for interventional treatment. Few clinical trials have evaluated treatments for neck pain. Exercise treatment appears to be beneficial in patients with neck pain. There is some evidence to support muscle relaxants in acute neck pain associated with muscle spasm, conflicting evidence for epidural corticosteroid injections for radiculopathy, and weak positive evidence for cervical facet joint radiofrequency denervation. In patients with radiculopathy or myelopathy, surgery appears to be more effective than nonsurgical therapy in the short term but not in the long term for most people.

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“…Moreover, the persistence of the M1 component correlates with persistence of symptoms [13]. However, recently the clinical relevance of MC has been questioned, as in prospective studies, MC were not indicated as having any prognostic role in future low back symptoms [14,15]. …”

Section: Introductionmentioning

confidence: 99%

Efficacy of zoledronic acid for chronic low back pain associated with Modic changes in magnetic resonance imaging

Koivisto

Kyllönen

Haapea

et al. 2014

BMC Musculoskelet Disord

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Background: Modic changes (MC) are associated with low back pain (LBP), but effective treatments are lacking. The aim of this randomized, placebo-controlled, double-blinded trial was to evaluate the efficacy of zoledronic acid (ZA) for chronic LBP among patients with MC in magnetic resonance imaging (MRI). Methods: Inclusion criteria were LBP lasting ≥3 months, with an intensity of ≥6 on a 10-cm VAS or an Oswestry Disability Index (ODI) of ≥30%, and MC in MRI. Patients were randomized into single intravenous infusion of ZA 5 mg (n = 20), or placebo (n = 20) groups. The primary outcome was LBP intensity, secondary outcomes leg pain intensity, ODI, health-related quality of life (RAND-36), lumbar flexibility, sick leaves and use of pain medication. The treatment differences at one month and one year were analysed using ANCOVA with adjustment for the baseline score. Results: The mean difference (MD) between the groups in the primary outcome, intensity of LBP, was 1.4 (95% confidence intervals (CI) 0.01 to 2.9) in favour of ZA at one month. We observed no significant between-group difference in the intensity of LBP at one year (MD 0.7; 95% CI −1.0 to 2.4) or in secondary outcomes at any time point except that 20% of patients in the ZA group used non-steroidal anti-inflammatory drugs at one year compared to 60% in the placebo group (P = 0.022). Acute phase reactions (fever, flu-like symptoms, arthralgia) emerged in 95% of the patients in the ZA group, compared to 35% in the placebo group. Conclusions: ZA was effective in reducing the intensity of LBP in the short term and in reducing the use of NSAIDs within the time span of one year among patients with chronic LBP and MC confirmed in MRI. Although the results seem encouraging, larger studies are required to analyse the effectiveness and safety of ZA for patients with MC. Trial registration: ClinicalTrial.gov identifier NCT01330238.

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Prognostic Factors of Prolonged Disability in Patients With Chronic Low Back Pain and Lumbar Degeneration in Primary Care

Abstract: Increased pain-related disability at 1 year was seen in patients with impaired fasting glucose tolerance, greater pain-related disability, higher BMI, and lower quality of life at baseline.

Cited by 51 publications

References 72 publications

The ‘Lumbar Fusion Outcome Score’ (LUFOS): a new practical and surgically oriented grading system for preoperative prediction of surgical outcomes after lumbar spinal fusion in patients with degenerative disc disease and refractory chronic axial low back pain

The ‘Lumbar Fusion Outcome Score’ (LUFOS): a new practical and surgically oriented grading system for preoperative prediction of surgical outcomes after lumbar spinal fusion in patients with degenerative disc disease and refractory chronic axial low back pain

Epidemiology, Diagnosis, and Treatment of Neck Pain

Efficacy of zoledronic acid for chronic low back pain associated with Modic changes in magnetic resonance imaging

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