Progression of Spinal MRI Findings Predicts Change in Disability in Young Adults With Back Pain

Prospective cohort study.

To investigate associations between the progression of spinal MRI findings and changes in disability over four years, among young adults with low back pain (LBP).

Spinal MRI findings evolve over time, with some stabilizing, improving, or progressing, and such temporal changes may be relevant for understanding causal relationships with back pain. The clinical relevance of temporal changes may also depend on the number, severity, and location across the spine.

The study included 561 participants (18-40 yr, 54% women, follow-up rate 54% of baseline cohort) referred to an outpatient hospital spine clinic with LBP. Disability was assessed using the Roland Morris Disability Questionnaire (rescaled to 0-100). Whole-spine MRI was obtained at baseline and four-year follow-up. Progression (defined as new or worsening findings) of vertebral endplate signal changes (VESC), disc degeneration, and disc herniations was assessed.

The mean baseline disability score was 56 (95% CI: 55-58), with a mean improvement of 18 (16-21) points over four years. When MRI progression was analysed separately by findings (VESC, disc degeneration, and disc herniations) and by region (cervical, thoracic, lumbar), only a few specific findings were associated with changes in disability. In contrast, broader measures of MRI progression, incorporating findings across the whole spine and summarised as either binary or continuous variables, were associated with less improvement in disability. Specifically, any progression in the whole spine (binary predictor) was associated with 5.1 points (0.3-10.0) less improvement. Furthermore, cumulative progression of MRI findings (continuous predictor) was associated with less improvement in disability (beta=0.6, 95% CI: 0.2-1.0).

Progression of MRI findings across the whole spine was associated with less improvement in disability. The results suggest that new or worsening structural changes may impact back pain outcomes and may further depend on their distribution and cumulative burden over time.