MRI Studies: More Findings Associated with Low Back Pain

This week from Dr. Cerami and Utah Sports and Wellness

From: Spine, September 2017

Quick Summary:

This study was performed to determine if there is a correlation between multiple MRI findings or single MRI findings in cases of low back pain. With data collected from more than 400 subjects, the authors concluded that, “The risk of LBP outcome increased with increasing numbers of different MRI findings.” The four MRI findings that were most likely to be found in these low back pain subjects were; modic change, high intensity zone, disc height narrowing and spondylolisthesis. Importantly, “spondylolisthesis had a statistically significant univariate association with LBP in the last year.” The “finding showed that the odds of having LBP in the last year increased with the number of MRI findings present.” “In those with 3 or 4 MRI findings present, the odds of LBP in the last year were 14.1 times greater [1,410%] than in people with no MRI findings.”

Abstract:

A cross-sectional and longitudinal analysis using 2 different data sets OBJECTIVE.: To investigate if the number of different MRI findings present is more strongly associated with low back pain (LBP) than single MRI findings. Summary of background data: Most previous studies have investigated the associations between single MRI findings and back pain rather than investigating combinations of MRI findings. If different individuals have different pathoanatomic sources contributing to their pain, then combinations of MRI findings may be more strongly associated with LBP. Methods: This study used data from two previous studies that investigated the association between single MRI findings and LBP. One study was a cross-sectional population cohort of 412 forty-year old people, the second was a longitudinal cohort of 76 people recently recovered from LBP who were followed for 12 months. The outcome for the cross-sectional study was presence of LBP during the last year. The outcome for the longitudinal study was days to recurrence of activity limiting LBP. In both data sets we created an aggregate score of the number of different MRI findings present in each individual and assessed the relationship between this aggregate score and LBP. Results: The risk of LBP outcome increased with increasing numbers of different MRI findings. Compared to those with no MRI findings, those with 3 MRI findings were at substantially greater risk of LBP in the last year (Odd Ratio = 14.1; 95%CI 4.32 to 49.47) in the cross-sectional study, or of future recurrence of LBP (Hazard Ratio = 12.2; 95%CI 1.26 to 118.21) in the longitudinal study. Conclusions: The aggregate MRI score was more strongly associated with LBP outcomes than single MRI findings in both data sets. Further investigation of this approach is indicated. Level of evidence: 2.

These authors also note:

• Studies indicate that single pathology on MRI is “only weakly related to LBP and of little importance.” As such, this study investigated combinations of MRI findings.
• The authors concluded that the “aggregate MRI score was more strongly associated with LBP outcomes than single MRI findings in both datasets.”
• “The risk of LBP outcome increased with increasing numbers of different MRI findings.”
• “Compared with those with no MRI findings, those with three MRI findings were at substantially greater risk of LBP in the last year.” [In one study it was a 1400% increased risk, and in the other study it was 1200% increased risk]
• The “finding showed that the odds of having LBP in the last year increased with the number of MRI findings present.”
• “In those with 3 or 4 MRI findings present, the odds of LBP in the last year were 14.1 times greater [1,410%] than in people with no MRI findings.”
• The risk of “having a future recurrence of LBP was 12.2 times [1,220%] greater in those people with three MRI findings present than in those people with no MRI findings.”
• “Our results suggest that those at high risk of recurrences may be able to be better identified and prevention approaches could be tested in these individuals. Patients with widespread MRI pathology may represent a specific phenotype, who require different interventions to those with localized or no pathology.”
• “This study found an aggregate MRI score of the number of different MRI findings was more strongly associated with LBP outcomes than single MRI findings.”
• “The risk of previous and future LBP increased with increasing numbers of different MRI findings.”
• “Compared with those with no MRI findings, those with three MRI findings were at substantially greater risk of LBP in the last year.”