The prevalence of MRI-defined spinal pathoanatomies and their association with Modic changes in individuals seeking care for low back pain

Albert, H; Briggs, Andrew M.; Kent, Peter; Byrhagen, Andreas; Hansen, Christian J.; Kjaergaard, Karina

doi:10.1007/s00586-011-1794-6

Cited by 85 publications

(69 citation statements)

References 35 publications

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“…Although diagnostic codes were not available in the data from either setting, SBT was originally validated in people diagnosed by GPs as having non-specific LBP. In our secondary care setting, approximately 45 % have MRI evidence of central stenosis or nerve root compromise [16] and this may have affected their recovery trajectories and, thereby, the predictive ability of the SBT. Another potential factor affecting the predictive ability could be a social class bias that we believe results in an over-representation of lower sociodemographics in the secondary care cohort.…”

Section: Discussionmentioning

confidence: 99%

“…This inclusion criteria resulted in 20.8 % (250 patients) otherwise eligible patients being excluded. No diagnostic data were available in the database but using magnetic resonance imaging to document the presence of lumbar patho-anatomic findings, previous descriptive research on this clinical population showed that approximately 0.5 % or less have serious pathology (tumour, fracture, tuberculosis), 15 % have central stenosis, 29 % have nerve root compromise and the remainder have nonspecific LBP [16].…”

Section: Methodsmentioning

confidence: 99%

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The predictive ability of the STarT Back Screening Tool in a Danish secondary care setting

et al. 2013

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Introduction The predictive ability of the STarT Back Tool (SBT) in secondary care settings has not been investigated. The aim of this study was to determine the SBT's predictive ability in a Danish secondary care setting and compare this to a Danish primary care setting. Methods Poor clinical outcome at 6 months ([30 points on a 0-100 Roland Morris Disability Scale) was calculated in secondary care (n = 960) and primary care (n = 172) cohorts. The cohorts were stratified into SBT subgroups and estimates of additional risk for poor outcome were calculated [relative risk (RR), unadjusted and adjusted odds ratios]. The discriminative ability was determined using the area under the curve statistic. Results In secondary care 69.0 % and in primary care 40.2 % had poor outcome on activity limitation. Although significant, the predictive ability of the SBT in secondary care (medium-risk RR 1.5, high-risk RR 1.7) was not as strong as in primary care (medium-risk RR 2.3, high-risk RR 3.5). Adjusting for episode duration and pain intensity only changed the predictive ability marginally in secondary care. The discriminative ability of the SBT was similar in both cohorts despite differences in the predictive ability. Conclusion The SBT had less predictive ability in a Danish secondary care setting compared to a Danish primary care setting for persistent activity limitation at 6 months follow-up. SBT-targeted treatment implications in secondary care were not investigated in this study.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The predictive ability of the STarT Back Screening Tool in a Danish secondary care setting

et al. 2013

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“…Lumbar disc degeneration and herniation is regarded as a risk factor for developing MC, especially MC I [7][8][9]. Patients with lumbar disc herniation often have a combination of low back pain and radicular pain.…”

Section: Introductionmentioning

confidence: 99%

Modic type I changes and recovery of back pain after lumbar microdiscectomy

et al. 2012

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Purpose To investigate whether the presence of Modic changes type I (MC I) found on preoperative MRI scans represent a risk factor for persistent back pain 12 months after surgery amongst patients operated for lumbar disc herniation. Methods Cohort study of 178 consecutive patients operated with lumbar microdiscectomy. Preoperative MRI scans were evaluated by two independent neuroradiologists. Primary outcome measure was the visual analogue scale (VAS) for back pain. Secondary outcome measures were; VAS for leg pain, physical function (Oswestry Disability Index), and health-related quality of life (EQ-5D), self-reported benefit of the operation and employment status. The presence of MC I was used as exposition variable and adjusted for other risk factors in multivariate analyses. Results The Modic classification showed a high interobserver reproducibility. Patients with MC I had less improvement of back pain 12 months after surgery, compared to those who had no or other types of MC, but this negative association no longer showed statistical significance when adjusted for smoking, which remained the only independent risk factor for persistent back pain. Conclusions Patients with preoperative MC I can expect less but still significant improvement of back pain 1 year after microdiscectomy, but not if they smoke cigarettes.

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Section: The Factsmentioning

confidence: 95%

“…A further systematic review in the same year from Shanghai [7] identified two possible pathophysiological mechanisms for Modic changes-one biomechanical and one biochemical. A biomechanical pathway for development of Modic changes was supported by a large population MRI scan study in 2011 [8].Against this background two key papers were then published in this journal in 2013. In one study [2] Albert and colleagues established a strong relationship between…”

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confidence: 95%

Antibiotics a cure for back pain, a false dawn or a new era?

O’Dowd

Casey

2013

Eur Spine J

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The recent publication in this journal of papers by Albert and colleagues [1,2] from Denmark suggesting that low grade anaerobic bacterial infection may be the underlying cause of significant persistent chronic back pain in a welldefined group of patients has precipitated an unprecedented response in the medical and lay media. In the midst of claim and counterclaim, these studies represent a significant and substantial change in our understanding of the pathophysiology of back pain in some patient groups, and the importance of this should not be lost amidst the negative, unstructured and unscientific response to this study. The factsThe story starts in 2001 with the publication of a research letter in the Lancet by a group from Birmingham [3] demonstrating that 31 % of patients with sciatica tested positive to a newly developed serological test, which diagnosed deep-seated infections caused by virulent Grampositive microorganisms. In addition, intervertebral disc material excised during microdiscectomy in a different group of patients, which was cultured in a specialist anaerobic environment, had positive cultures after longterm incubation in 53 % of patients and of this group 84 % grew Propionibacterium acnes.Following the ISSLS 2006 meeting, a collaboration developed between the Birmingham group and the group from Southern Denmark. This led to publication of a pilot study in 2008 [4] where 32 chronic low back pain patients with Modic type 1 endplate changes and a previous lumbar herniated disc were treated with amoxicillin and clavulanate for 90 days. In this uncontrolled trial, there was a clinically important and statistically significant difference in outcome at 10-month follow-up following antibiotic treatment.In the meantime, the evidence was accumulating about the significant correlation between Modic endplate changes and back pain. Albert and Manniche [5] identified a strong association between Modic changes and non-specific low back pain, a stronger association with Modic type 1 than type 2, and that a lumbar disc herniation is a strong risk factor for developing Modic changes, especially type 1, during the following year and that these changes are strongly associated with low back pain.A systematic review from Southern Denmark in 2008 [6] identified the prevalence of vertebral endplate signal changes as 43 % in patients with non-specific low back pain and/or sciatica, and 6 % in a non-clinical population, demonstrating that endplate changes are associated with pain. A further systematic review in the same year from Shanghai [7] identified two possible pathophysiological mechanisms for Modic changes-one biomechanical and one biochemical. A biomechanical pathway for development of Modic changes was supported by a large population MRI scan study in 2011 [8].Against this background two key papers were then published in this journal in 2013. In one study [2] Albert and colleagues established a strong relationship between

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The prevalence of MRI-defined spinal pathoanatomies and their association with Modic changes in individuals seeking care for low back pain

Cited by 85 publications

References 35 publications

The predictive ability of the STarT Back Screening Tool in a Danish secondary care setting

The predictive ability of the STarT Back Screening Tool in a Danish secondary care setting

Modic type I changes and recovery of back pain after lumbar microdiscectomy

Antibiotics a cure for back pain, a false dawn or a new era?

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