nach oben

Erschienen in:

01.11.2013 | Scientific Article

Do more MRI findings imply worse disability or more intense low back pain? A cross-sectional study of candidates for lumbar disc prosthesis

verfasst von: Linda Berg, Christian Hellum, Øivind Gjertsen, Gesche Neckelmann, Lars Gunnar Johnsen, Kjersti Storheim, Jens Ivar Brox, Geir Egil Eide, Ansgar Espeland, The Norwegian Spine Study Group

Erschienen in: Skeletal Radiology | Ausgabe 11/2013

Einloggen, um Zugang zu erhalten

Abstract

Objective

To examine whether combined magnetic resonance imaging (MRI) findings are related to the degree of disability and low back pain (LBP) in candidates for lumbar disc prosthesis surgery.

Materials and methods

This cross-sectional study included 170 disc prosthesis candidates (mean age 41 years; 88 women) with chronic non-radicular LBP and localized disc degeneration. Experienced radiologists rated Modic changes and disc findings at L4-S1 on pre-treatment MRIs. An MRI total score (0–10) for findings at L4/L5 plus L5/S1 was calculated for Modic type I and/or II changes, a posterior high intensity zone (HIZ) in the disc, dark/black nucleus pulposus signal, and ≥40 % disc height decrease. We analyzed the relationship of the MRI total score to the Oswestry Disability Index (ODI) (n = 170) and LBP intensity scores (0–100 visual analogue scale, n = 165) using multiple linear regression and adjusting for age, gender, body mass index, smoking, and anxiety/depression.

Results

The MRI total score was not related to ODI (regression coefficient 0.12, p = 0.79) or LBP intensity (regression coefficient 0.64, p = 0.37). When individual MRI findings were analyzed, patients with HIZ at L5/S1 had slightly lower ODI scores (4.7 points, p = 0.02). In post hoc analyses, results remained unchanged after adding facet arthropathy to the MRI total score and adjusting also for physical workload and physical leisure-time activity.

Conclusions

The combined MRI findings were not related to the degree of disability or the intensity of LBP. These degenerative MRI findings cannot explain variation in pre-treatment disability and pain in patients with chronic LBP accepted for disc prosthesis surgery.

Nur mit Berechtigung zugänglich

Emch TM, Modic MT. Imaging of lumbar degenerative disk disease: history and current state. Skeletal Radiol. 2011;40:1175–89.PubMedCrossRef

Chou D, Samartzis D, Bellabarba C, et al. Degenerative magnetic resonance imaging changes in patients with chronic low back pain: a systematic review. Spine. 2011;36:S43–53 (Phila Pa 1976).PubMedCrossRef

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;17:1407–22.PubMedCrossRef

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. 2011;36:160–9 (Phila Pa 1976).PubMedCrossRef

Mariconda M, Galasso O, Imbimbo L, Lotti G, Milano. Relationship between alterations of the lumbar spine, visualized with magnetic resonance imaging, and occupational variables. Eur Spine J. 2007;16:255–66.PubMedCrossRef

Arana E, Marti-Bonmati L, Vega M, et al. Relationship between low back pain, disability, MR imaging findings and health care provider. Skeletal Radiol. 2006;35:641–7.PubMedCrossRef

Modic MT, Ross JS. Lumbar degenerative disk disease. Radiology. 2007;245:43–61.PubMedCrossRef

Blumenthal S, McAfee PC, Guyer RD, et al. A prospective, randomized, multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part I: evaluation of clinical outcomes. Spine. 2005;30:1565–75; discussion E387–91 (Phila Pa 1976).

Berg S, Tullberg T, Branth B, Olerud C, Tropp H. Total disc replacement compared to lumbar fusion: a randomised controlled trial with 2-year follow-up. Eur Spine J. 2009;18:1512–9.PubMedCrossRef

10.

Hellum C, Johnsen LG, Storheim K, et al. Surgery with disc prosthesis versus rehabilitation in patients with low back pain and degenerative disc: two-year follow-up of randomised study. BMJ 2011;342:d2786 doi:10.1136/bmj.d2786

11.

Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976) 2000;25:2940–2952; discussion 2952.

12.

American College of Radiology (ACR), American Society of Neuroradiology (ASNR), Society of Computed Body Tomography and Magnetic Resonance (SCBT-MR). ACR-ASNR-SCBT-MR Practice Guideline for the Performance of Magnetic Resonance imaging (MRI) of the Adult Spine. Resolution 15. 2012. http://www.asnr.org/sites/default/files/guidelines/MRI_Adult_Spine.pdf Accessed 9 July 2013.

13.

Carrino JA, Morrison WB. Imaging of lumbar degenerative disc disease. Semin Spine Surg. 2003;15:361–83.CrossRef

14.

Berg L, Neckelmann G, Gjertsen Ø, et al. Reliability of MRI findings in candidates for lumbar disc prosthesis. Neuroradiology. 2012;54:699–707. doi:10.1007/s00234-011-0963-y

15.

Jensen TS, Sorensen JS, Kjaer P. Intra- and interobserver reproducibility of vertebral endplate signal (Modic) changes in the lumbar spine: the Nordic Modic Consensus Group classification. Acta Radiol. 2007;48:748–54.PubMedCrossRef

16.

Fardon DF, Milette PC. Nomenclature and classification of lumbar disc pathology. Recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine. 2001;26:E93–E113 (Phila Pa 1976).PubMedCrossRef

17.

Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166:193–9.PubMed

18.

Carrino JA, Lurie JD, Tosteson AN, et al. Lumbar spine: reliability of MR imaging findings. Radiology. 2009;250:161–70.PubMedCrossRef

19.

Aprill C, Bogduk N. High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br J Radiol. 1992;65:361–9.PubMedCrossRef

20.

Luoma K, Riihimaki H, Luukkonen R, Raininko R, Viikari-Juntura E, Lamminen A. Low back pain in relation to lumbar disc degeneration. Spine. 2000;25:487–92 (Phila Pa 1976).PubMedCrossRef

21.

Solgaard Sorensen J, Kjaer P, Jensen ST, Andersen P. Low-field magnetic resonance imaging of the lumbar spine: reliability of qualitative evaluation of disc and muscle parameters. Acta Radiol. 2006;47:947–53.PubMedCrossRef

22.

Raininko R, Manninen H, Battie MC, Gibbons LE, Gill K, Fisher LD. Observer variability in the assessment of disc degeneration on magnetic resonance images of the lumbar and thoracic spine. Spine. 1995;20:1029–35 (Phila Pa 1976).PubMedCrossRef

23.

Videman T, Battie MC, Gibbons LE, Maravilla K, Manninen H, Kaprio J. Associations between back pain history and lumbar MRI findings. Spine. 2003;28:582–8 (Phila Pa 1976).PubMed

24.

Masharawi Y, Kjaer P, Bendix T, et al. The reproducibility of quantitative measurements in lumbar magnetic resonance imaging of children from the general population. Spine. 2008;33:2094–100 (Phila Pa 1976).PubMedCrossRef

25.

Fujiwara A, Tamai K, Yamato M, et al. The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J. 1999;8:396–401.PubMedCrossRef

26.

Kjaer P, Leboeuf-Yde C, Korsholm L, Sorensen JS, Bendix T. Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine. 2005;30:1173–80 (Phila Pa 1976).PubMedCrossRef

27.

Grotle M, Brox JI, Vollestad NK. Cross-cultural adaptation of the Norwegian versions of the Roland-Morris Disability Questionnaire and the Oswestry Disability Index. J Rehabil Med. 2003;35:241–7.PubMedCrossRef

28.

Smeets R, Koke A, Lin CW, Ferreira M, Demoulin C. Measures of function in low back pain/disorders: Low Back Pain Rating Scale (LBPRS), Oswestry Disability Index (ODI), Progressive Isoinertial Lifting Evaluation (PILE), Quebec Back Pain Disability Scale (QBPDS), and Roland-Morris Disability Questionnaire (RDQ). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S158–73.CrossRef

29.

Leren P, Askevold EM, Foss OP, et al. The Oslo study. Cardiovascular disease in middle-aged and young Oslo men. Acta Med Scand Suppl. 1975;588:1–38.PubMed

30.

Browner WS, Newman TB, Hulley SB. Estimating sample size and power: applications and examples. In: Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB, editors. Designing clinical research. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 65–94.

31.

Bendix T, Sorensen JS, Henriksson GA, Bolstad JE, Narvestad EK, Jensen TS. Lumbar Modic changes—a comparison between findings at low- and high-field magnetic resonance imaging. Spine. 2012;37:1756–62 (Phila Pa 1976).PubMedCrossRef

32.

Bankier AA, Levine D, Halpern EF, Kressel HY. Consensus interpretation in imaging research: is there a better way? Radiology. 2010;257:14–7.PubMedCrossRef

33.

Espeland A, Vetti N, Krakenes J. Are two readers more reliable than one? A study of upper neck ligament scoring on magnetic resonance images. BMC Med Imaging. 2013;13:4.PubMedCrossRef

34.

Jarvik JG, Deyo RA. Moderate versus mediocre: the reliability of spine MR data interpretations. Radiology. 2009;250:15–7.PubMedCrossRef

35.

Newman TB, Browner WS, Hulley SB. Enhancing causal interference in observational studies. In: Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB, editors. Designing clinical research. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 127–46.

36.

Battie MC, Videman T, Kaprio J, et al. The twin spine study: contributions to a changing view of disc degeneration. Spine J. 2009;9:47–59.PubMedCrossRef

37.

Battie MC, Videman T. Lumbar disc degeneration: epidemiology and genetics. J Bone Joint Surg Am. 2006;88 Suppl 2:3–9.PubMedCrossRef

38.

Carragee EJ, Alamin TF, Miller JL, Carragee JM. Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine J. 2005;5:24–35.PubMedCrossRef

39.

Samartzis D, Karppinen J, Chan D, Luk KD, Cheung KM. The association of lumbar intervertebral disc degeneration on magnetic resonance imaging with body mass index in overweight and obese adults: a population-based study. Arthritis Rheum. 2012;64:1488–96.PubMedCrossRef

40.

Takatalo J, Karppinen J, Niinimaki J, et al. Does lumbar disc degeneration on magnetic resonance imaging associate with low back symptom severity in young Finnish adults? Spine. 2011;36:2180–9 (Phila Pa 1976).PubMedCrossRef

41.

Landmark T, Romundstad P, Borchgrevink PC, Kaasa S, Dale O. Associations between recreational exercise and chronic pain in the general population: evidence from the HUNT 3 study. Pain. 2011;152:2241–7.PubMedCrossRef

42.

Kirkwood BR, Sterne JAC. Regression modelling. In: Kirkwood BR, Sterne JAC, editors. Essential medical statistics. Oxford: Blackwell Publishing Ltd; 2003. p. 315–42.

43.

Siepe CJ, Zelenkov P, Sauri-Barraza JC, et al. The fate of facet joint and adjacent level disc degeneration following total lumbar disc replacement: a prospective clinical, X-ray, and magnetic resonance imaging investigation. Spine. 2010;35:1991–2003 (Phila Pa 1976).PubMedCrossRef

44.

McAfee PC. The indications for lumbar and cervical disc replacement. Spine J. 2004;4:177S–81S.PubMedCrossRef

45.

Sheehan NJ. Magnetic resonance imaging for low back pain: indications and limitations. Ann Rheum Dis. 2010;69:7–11.PubMedCrossRef

46.

Gibson JN, Waddell G. Surgery for degenerative lumbar spondylosis: updated Cochrane Review. Spine. 2005;30:2312–20 (Phila Pa 1976).PubMedCrossRef

47.

Kleinstuck F, Dvorak J, Mannion AF. Are “structural abnormalities” on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic nonspecific low back pain? Spine. 2006;31:2250–7 (Phila Pa 1976).PubMedCrossRef

Titel: Do more MRI findings imply worse disability or more intense low back pain? A cross-sectional study of candidates for lumbar disc prosthesis
verfasst von: Linda Berg
Christian Hellum
Øivind Gjertsen
Gesche Neckelmann
Lars Gunnar Johnsen
Kjersti Storheim
Jens Ivar Brox
Geir Egil Eide
Ansgar Espeland
The Norwegian Spine Study Group
Publikationsdatum: 01.11.2013
Verlag: Springer Berlin Heidelberg
Erschienen in: Skeletal Radiology / Ausgabe 11/2013
Print ISSN: 0364-2348
Elektronische ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-013-1700-x

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Do more MRI findings imply worse disability or more intense low back pain? A cross-sectional study of candidates for lumbar disc prosthesis