Subacute and Chronic Low-Back Pain: From MRI Phenotype to Imaging-Guided Interventions

Area of Science:

• Radiology
• Interventional Pain Management
• Spine Imaging

Background:

• Low-back pain (LBP) is a significant global cause of disability.
• Magnetic Resonance Imaging (MRI) is crucial for diagnosing persistent LBP, suspected red flags, or guiding procedures.
• Current approaches often lack a clear link between imaging findings and specific interventions.

Purpose of the Study:

• To present a practical, radiology-led framework for subacute and chronic LBP.
• To integrate MRI-based phenotyping with image-guided interventions.
• To align imaging phenotypes with anatomical targets and appropriate treatments.

Main Methods:

• Narrative review defining operational MRI criteria for radicular vs. non-radicular phenotypes.
• Summarizing MRI-based phenotyping for endplate/Modic and facet/sacroiliac degenerative changes.
• Outlining selection, technique, guidance modalities (fluoroscopy, CT, ultrasound), safety, and efficacy for major image-guided interventions.

Main Results:

• Defined MRI criteria to distinguish LBP phenotypes.
• Detailed selection and techniques for interventions like epidural injections, radiofrequency ablation (RFA), basivertebral nerve ablation (BVNA), and vertebral augmentation.
• Proposed a phenotype-driven reporting template and care pathway linking MRI patterns to interventions.

Conclusions:

• A standardized phenotype → target → tool approach enhances MRI report actionability for LBP.
• This strategy aids clinicians in selecting appropriate image-guided interventions, improving patient outcomes.
• Prioritizes safety and value by reducing unnecessary testing and therapeutic uncertainty.