Longitudinal associations between incident lumbar spine MRI findings and chronic low back pain or radicular symptoms: retrospective analysis of data from the longitudinal assessment of imaging and disability of the back (LAIDBACK)

BMC Musculoskeletal Disorders

Jeffrey G Jarvik⁵  Christopher W Forsberg⁴  Jack Goldberg¹  Edward J Boyko³  Pradeep Suri² 

[1]Department of Epidemiology, University of Washington School of Public Health, Seattle, WA USA

[2]Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA USA

[3]Department of Medicine, University of Washington School of Medicine, Seattle, WA USA

[4]Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA USA

[5]Department of Health Services, University of Washington School of Public Health, Seattle, WA USA

关键词: Disc;    Zygapophyseal;    Arthritis;    Facet;    Spondylolisthesis;    Extrusion;    Stenosis;    Modic;    Endplate;    Impingement;    Bulge;    Herniation;    Fissure;    Tear;    Annular;    Sciatica;   

Others  :  1127628
DOI  :  10.1186/1471-2474-15-152

 received in 2013-11-20, accepted in 2014-05-06,  发布年份 2014

【 摘 要 】

Background

There are few longitudinal cohort studies examining associations between incident MRI findings and incident spine-related symptom outcomes. Prior studies do not discriminate between the two distinct outcomes of low back pain (LBP) and radicular symptoms. To address this gap in the literature, we conducted a secondary analysis of existing data from the Longitudinal Assessment of Imaging and Disability of the Back (LAIDBACK). The purpose of this study was to examine the association of incident lumbar MRI findings with two specific spine-related symptom outcomes: 1) incident chronic bothersome LBP, and 2) incident radicular symptoms such as pain, weakness, or sensation alterations in the lower extremity.

Methods

The original LAIDBACK study followed 123 participants without current LBP or sciatica, administering standardized MRI assessments of the lumbar spine at baseline and at 3-year follow-up, and collecting information on participant-reported spine-related symptoms and signs every 4 months for 3 years. These analyses examined bivariable and multivariable associations between incident MRI findings and symptom outcomes (LBP and radicular symptoms) using logistic regression.

Results

Three-year cumulative incidence of new MRI findings ranged between 2 and 8%, depending on the finding. Incident annular fissures were associated with incident chronic LBP, after adjustment for prior back pain and depression (adjusted odds ratio [OR] 6.6; 95% confidence interval [CI] 1.2-36.9). All participants with incident disc extrusions (OR 5.4) and nerve root impingement (OR 4.1) reported incident radicular symptoms, although associations were not statistically significant. No other incident MRI findings showed large magnitude associations with symptoms.

Conclusions

Even when applying more specific definitions for spine-related symptom outcomes, few MRI findings showed large magnitude associations with symptom outcomes. Although incident annular fissures, disc extrusions, and nerve root impingement were associated with incident symptom outcomes, the 3-year incidence of these MRI findings was extremely low, and did not explain the vast majority of incident symptom cases.

【 授权许可】

   
2014 Suri et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK: Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007, 147(7):478-491.
• [2]Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW: Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990, 72(3):403-408.
• [3]Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS: Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994, 331(2):69-73.
• [4]Chou D, Samartzis D, Bellabarba C, Patel A, Luk KD, Kisser JM, Skelly AC: Degenerative magnetic resonance imaging changes in patients with chronic low back pain: a systematic review. Spine (Phila Pa 1976) 2011, 36(21 Suppl):S43-S53.
• [5]Endean A, Palmer KT, Coggon D: Potential of magnetic resonance imaging findings to refine case definition for mechanical low back pain in epidemiological studies: a systematic review. Spine (Phila Pa 1976) 2011, 36(2):160-169.
• [6]Zhang Y, Zhang B, Wise B, Niu J, Zhu Y: Statistical approaches to evaluating the effect of risk factors on the pain of knee osteoarthritis in longitudinal studies. Curr Opin Rheumatol 2009, 21(5):513-519.
• [7]Dionne CE, Dunn KM, Croft PR, Nachemson AL, Buchbinder R, Walker BF, Wyatt M, Cassidy JD, Rossignol M, Leboeuf-Yde C, Hartvigsen J, Leino-Arjas P, Latza U, Reis S, Gil Del Real MT, Kovacs FM, Oberg B, Cedraschi C, Bouter LM, Koes BW, Picavet HS, van Tulder MW, Burton K, Foster NE, Macfarlane GJ, Thomas E, Underwood M, Waddell G, Shekelle P, Volinn E, et al.: A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine 2008, 33(1):95-103.
• [8]da Costa CML, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO: The prognosis of acute and persistent low-back pain: a meta-analysis. Cmaj 2012, 184(11):E613-E624.
• [9]Katz JN: Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am 2006, 88(Suppl 2):21-24.
• [10]Videman T, Battie MC: Commentary: back pain epidemiology–the challenge of case definition and developing new ideas. Spine J 2012, 12(1):71-72.
• [11]Stanton TR, Henschke N, Maher CG, Refshauge KM, Latimer J, McAuley JH: After an episode of acute low back pain, recurrence is unpredictable and not as common as previously thought. Spine (Phila Pa 1976) 2008, 33(26):2923-2928.
• [12]Suri P, Rainville J, Fitzmaurice GM, Katz JN, Jamison RN, Martha J, Hartigan C, Limke J, Jouve C, Hunter DJ: Acute low back pain is marked by variability: An internet-based pilot study. BMC Musculoskelet Disord 2011, 12:220. BioMed Central Full Text
• [13]Suri P, Saunders KW, Von Korff M: Prevalence and characteristics of flare-ups of chronic nonspecific back pain in primary care: a telephone survey. Clin J Pain 2012, 28(7):573-580.
• [14]Jarvik JG, Hollingworth W, Heagerty PJ, Haynor DR, Boyko EJ, Deyo RA: Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors. Spine (Phila Pa 1976) 2005, 30(13):1541-1548. discussion 1549
• [15]Jarvik JJ, Hollingworth W, Heagerty P, Haynor DR, Deyo RA: The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) Study: baseline data. Spine (Phila Pa 1976) 2001, 26(10)):1158-1166.
• [16]Patrick DL, Deyo RA, Atlas SJ, Singer DE, Chapin A, Keller RB: Assessing health-related quality of life in patients with sciatica. Spine (Phila Pa 1976) 1995, 20(17):1899-1908. discussion 1909
• [17]Von Korff M: Studying the natural history of back pain. Spine (Phila Pa 1976) 1994, 19(18 Suppl):2041S-2046S.
• [18]Hancock M, Maher C, Macaskill P, Latimer J, Kos W, Pik J: MRI findings are more common in selected patients with acute low back pain than controls? Eur Spine J 2012, 21(2):240-246.
• [19]Jensen TS, Karppinen J, Sorensen JS, Niinimaki J, Leboeuf-Yde C: Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J 2008, 17(11):1407-1422.
• [20]Goode AP, Carey TS, Jordan JM: Low back pain and lumbar spine osteoarthritis: how are they related? Curr Rheumatol Rep 2013, 15(2):305.
• [21]Goode AP, Marshall SW, Renner JB, Carey TS, Kraus VB, Irwin DE, Sturmer T, Jordan JM: Lumbar spine radiographic features and demographic, clinical, and radiographic knee, hip, and hand osteoarthritis. Arthritis Care Res (Hoboken) 2012, 64(10):1536-1544.
• [22]Suri P, Hunter DJ, Rainville J, Guermazi A, Katz JN: Presence and extent of severe facet joint osteoarthritis are associated with back pain in older adults. Osteoarthritis Cartilage 2013, 21(9):1199-1206.
• [23]Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN: The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum 2003, 49(2):156-163.
• [24]Bair MJ, Robinson RL, Katon W, Kroenke K: Depression and pain comorbidity: a literature review. Arch Intern Med 2003, 163(20):2433-2445.
• [25]Fitzmaurice GM, Laird NM, Zahner GE, Daskalakis C: Bivariate logistic regression analysis of childhood psychopathology ratings using multiple informants. Am J Epidemiol 1995, 142(11):1194-1203.
• [26]McCormick Z, Plastaras C: Lumbosacral transforaminal epidural steroid injections are equally effective for treatment of lumbosacral radicular pain in the obese compared to non-obese population: a pilot study. J Back Musculoskelet Rehabil 2013, 26(2):183-188.
• [27]Borenstein DG, O'Mara JW Jr, Boden SD, Lauerman WC, Jacobson A, Platenberg C, Schellinger D, Wiesel SW: The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects: a seven-year follow-up study. J Bone Joint Surg Am 2001, 83-A(9):1306-1311.
• [28]Elfering A, Semmer N, Birkhofer D, Zanetti M, Hodler J, Boos N: Risk factors for lumbar disc degeneration: a 5-year prospective MRI study in asymptomatic individuals. Spine (Phila Pa 1976) 2002, 27(2):125-134.
• [29]Jensen TS, Kjaer P, Korsholm L, Bendix T, Sorensen JS, Manniche C, Leboeuf-Yde C: Predictors of new vertebral endplate signal (Modic) changes in the general population. Eur Spine J 2010, 19(1):129-135.
• [30]Videman T, Battie MC, Gibbons LE, Maravilla K, Manninen H, Kaprio J: Associations between back pain history and lumbar MRI findings. Spine (Phila Pa 1976) 2003, 28(6):582-588.
• [31]Kovacs FM, Arana E, Royuela A, Estremera A, Amengual G, Asenjo B, Sarasibar H, Galarraga I, Alonso A, Casillas C, Muriel A, Martinez C, Abraira V: Vertebral endplate changes are not associated with chronic low back pain among Southern European subjects: a case control study. AJNR Am J Neuroradiol 2012, 33(8):1519-1524.
• [32]Komori H, Shinomiya K, Nakai O, Yamaura I, Takeda S, Furuya K: The natural history of herniated nucleus pulposus with radiculopathy. Spine (Phila Pa 1976) 1996, 21(2):225-229.
• [33]Benson RT, Tavares SP, Robertson SC, Sharp R, Marshall RW: Conservatively treated massive prolapsed discs: a 7-year follow-up. Ann R Coll Surg Engl 2010, 92(2):147-153.
• [34]Hancock MJ, Maher CG, Laslett M, Hay E, Koes B: Discussion paper: what happened to the 'bio' in the bio-psycho-social model of low back pain? Eur Spine J 2011, 20(12):2105-2110.