Degenerative Pathways of Lumbar Motion Segments--A Comparison in Two Samples of Patients with Persistent Low Back
Rikke K Jensen1, Per Kjaer1,2, Tue S Jensen1
1Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark.
Background:
Magnetic resonance imaging (MRI) is used to identify spinal pathoanatomy in people with persistent low back pain. However, the clinical relevance of spinal degenerative MRI findings remains uncertain. Although multiple MRI findings are almost always present at the same time, research into the association with clinical outcomes (such as pain) has predominantly focused on individual MRI findings. This study aimed to: (i) investigate how multiple MRI lumbar spine findings cluster together within two different samples of patients with low back pain, (ii) classify these clusters into hypothetical pathways of degeneration based on scientific knowledge of disco-vertebral degeneration, and (iii) compare these clusters and degenerative pathways between samples.
Methods:
We performed a secondary cross-sectional analysis on two dissimilar MRI samples collected in a hospital department: (1) data from the spinal MRI reports of 4,162 low back pain patients and (2) data from an MRI research protocol of 631 low back pain patients. Latent Class Analysis was used in both samples to cluster MRI findings from lumbar motion segments. Using content analysis, each cluster was then categorised into hypothetical pathways of degeneration.
Results:
Six clusters of MRI findings were identified in each of the two samples. The content of the clusters in the two samples displayed some differences but had the same overall pattern of MRI findings. Although the hypothetical degenerative pathways identified in the two samples were not identical, the overall pattern of increasing degeneration within the pathways was the same.
Conclusions:
It was expected that different clusters could emerge from different samples, however, when organised into hypothetical pathways of degeneration, the overall pattern of increasing degeneration was similar and biologically plausible. This evidence of reproducibility suggests that Latent Class Analysis may provide a new approach to investigating the relationship between MRI findings and clinically important characteristics such as pain and activity limitation.
Insights
Magnetic resonance imaging (MRI) of the spine reveals clusters of degenerative findings. These clusters, when organized into degeneration pathways, show a reproducible pattern across different patient samples, suggesting a new approach for low back pain research.
Area of Science:
- Radiology
- Orthopedics
- Biostatistics
Background:
- Spinal magnetic resonance imaging (MRI) is utilized to detect spinal abnormalities in individuals experiencing persistent low back pain.
- The clinical significance of degenerative findings on spinal MRI remains unclear, particularly how multiple co-occurring findings relate to patient outcomes.
- Current research often focuses on individual MRI findings rather than their collective patterns in low back pain patients.
Purpose of the Study:
- To investigate the clustering of multiple lumbar spine MRI findings in two distinct low back pain patient cohorts.
- To categorize these clusters into hypothetical degeneration pathways based on existing knowledge of disco-vertebral degeneration.
- To compare the identified clusters and degeneration pathways between the two patient samples.
Main Methods:
- Secondary cross-sectional analysis of two independent MRI datasets from low back pain patients (n=4,162 and n=631).
- Latent Class Analysis (LCA) was employed to identify distinct clusters of MRI findings within lumbar motion segments in both samples.
- Content analysis was used to classify each identified cluster into hypothetical pathways of spinal degeneration.
Main Results:
- Six distinct clusters of MRI findings were consistently identified in both patient samples.
- While the specific content of clusters showed some variation, the overall pattern of MRI findings was similar across samples.
- The hypothetical degeneration pathways, though not identical, demonstrated a consistent pattern of increasing degeneration in both datasets.
Conclusions:
- The study identified reproducible patterns of clustered spinal MRI findings when organized into hypothetical degeneration pathways.
- The observed similarity in degeneration patterns across different samples suggests biological plausibility and reproducibility.
- Latent Class Analysis presents a promising methodological approach for future research on the relationship between spinal MRI findings and clinical outcomes in low back pain.
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