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Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study
Richard Kasch1, Julia Truthmann2, Mark J Hancock3
1Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany.
Study Design:
Population-based cohort study.
Objective:
We examined associations between common lumbar degenerative changes observed on magnetic resonance imaging (MRI) and present or future low back pain (LBP).
Summary Of Background Data:
The association between lumbar MRI degenerative findings and LBP is unclear. Longitudinal studies are sparse.
Methods:
Participants (n = 3369) from a population-based cohort study were imaged at study entry, with LBP status measured at baseline and 6-year follow-up. MRI scans were reported on for the presence of a range of MRI findings. LBP status was measured on a 0 to 10 scale. Regression models were used to estimate the cross-sectional and longitudinal associations between individual and multiple MRI findings and LBP severity. Separate longitudinal analyses were conducted for participants with and without baseline pain.
Results:
MRI findings were present in persons with and without back pain at baseline. Higher proportions were found in older age groups. 76.4% of participants had a least one MRI finding and 8.3% had five or more different MRI findings. Cross-sectionally, most MRI findings were slightly more common in those with LBP and pain severity was slightly higher in those with MRI findings (ranging from 0.06 for high intensity zone to 0.83 for spondylolisthesis). In the longitudinal analyses, we found most MRI findings were not associated with future LBP-severity regardless of the presence or absence of baseline pain. Compared to zero MRI findings, having multiple MRI findings (five or more) was associated with mildly greater pain-severity at baseline (0.84; 0.50-1.17) and greater increase in pain-severity over 6 years in those pain free at baseline (1.21; 0.04-2.37), but not in those with baseline pain (-0.30; -0.99 to 0.38).
Conclusion:
Our study shows that the MRI degenerative findings we examined, individually or in combination, do not have clinically important associations with LBP, with almost all effects less than one unit on a 0 to 10 pain scale.Level of Evidence: 3.
Insights
Common lumbar MRI findings are not clinically associated with low back pain (LBP). Most degenerative changes on magnetic resonance imaging (MRI) do not predict future LBP severity, even with multiple findings.
Area of Science:
- Orthopedics and Musculoskeletal Health
- Radiology and Medical Imaging
- Epidemiology and Public Health
Background:
- The relationship between lumbar magnetic resonance imaging (MRI) degenerative findings and low back pain (LBP) remains unclear.
- Longitudinal studies investigating this association are notably scarce in existing literature.
Purpose of the Study:
- To examine associations between common lumbar degenerative changes on MRI and current or future LBP.
- To determine if specific MRI findings predict the severity or progression of LBP over time.
Main Methods:
- A population-based cohort study involving 3369 participants.
- MRI scans were acquired at study entry; LBP status and severity (0-10 scale) were assessed at baseline and 6-year follow-up.
- Regression models analyzed cross-sectional and longitudinal associations between individual/multiple MRI findings and LBP severity, with separate analyses for participants with and without baseline pain.
Main Results:
- 76.4% of participants exhibited at least one MRI finding, and 8.3% had five or more.
- Cross-sectionally, most MRI findings were slightly more prevalent in individuals with LBP.
- Longitudinally, most MRI findings were not associated with future LBP severity. Multiple findings (≥5) were linked to mildly greater baseline pain and a greater increase in pain over 6 years in initially pain-free individuals, but not in those with baseline pain.
Conclusions:
- The examined degenerative MRI findings, individually or combined, lack clinically significant associations with LBP.
- Observed effects on pain severity were generally less than one unit on a 0-10 scale.
- MRI findings alone may not be sufficient to explain or predict clinically relevant low back pain.
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