European Radiology

, Volume 29, Issue 12, pp 6405–6415 | Cite as

Prevalence of inflammatory posterior arch abnormalities on lumbar spine MRI in spondyloarthritis patients compared with low back pain patients

  • Hélène Braun
  • Clément Geniez
  • Yannick Degboe
  • Arnaud Constantin
  • Alain Cantagrel
  • Delphine Nigon
  • Nicolas Sans
  • Marie Faruch-Bilfeld
  • Adeline Ruyssen-WitrandEmail author



This study was conducted in order to compare the prevalence of inflammatory posterior arch abnormalities on lumbar spine MRI between axial spondyloarthritis (axSpA) patients and low back pain (LBP) patients.


Patients—axSpA patients meeting the 2009 ASAS criteria and chronic LBP patients who had a lumbar spine MRI were selected. MRI—STIR and T1 sagittal images up to T8–T9 were reviewed by two experienced rheumatologists blinded to the diagnosis and clinical data to identify inflammatory posterior arch abnormalities. Analyses—The prevalence of inflammatory posterior arch abnormalities between axSpA and LBP patients was compared. Clinical data were compared in the axSpA group depending on whether or not inflammatory posterior arch abnormalities were present.


Ninety-five patients were enrolled in each group. The prevalence of all inflammatory posterior arch abnormalities was the same in the axSpA and LBP groups (58% in the SpA group versus 70% in the LBP group, p = 0.1). However, differences in terms of the prevalence of costotransverse joint arthritis, pedicle oedema above L3 and transverse and spinous process oedema were observed between the two groups (axSpA 27% versus LBP 6%, p = 0.0004). Patients with inflammatory posterior arch abnormalities in the axSpA group had a longer disease duration (11 versus 8 years, p = 0.02), higher CRP levels (median 11 versus 3 mg/l, p = 0.0002) and higher prevalence of radiographic sacroiliitis (84 versus 47%, p = 0.001) compared to patients without inflammatory posterior arch abnormalities.


Costotransverse arthritis, pedicle oedema and transverse process oedema are more frequent in axSpA patients than LBP patients, on lumbar spine MRI depicting TH9-S1.

Key Points

• MRI pedicle oedema above L3, transverse process oedema, spinous process oedema or costotransverse arthritis is more frequently observed in axial spondyloarthritis (SpA).

• SpA patients with at least one MRI inflammatory lesion on the posterior arch had higher clinical activity scores and biological inflammation.

• Facet joint arthritis was more common in patients with chronic low back pain.


Spondylitis Ankylosing Magnetic resonance imaging Diagnosis Differential 



Assessment of Spondyloarthritis International Society


Ankylosing Spondylitis Disease Activity Score


Axial spondyloarthritis


Bath Ankylosing Spondylitis Disease Activity Index


Bath Ankylosing Spondylitis Functional Index


Biologic disease-modifying antirheumatic drugs


Vertebral corner inflammatory lesions


C-reactive protein


Costotransverse joint arthritis


Conventional synthetic disease-modifying antirheumatic drugs


Erythrocyte sedimentation rate


Facet joint arthropathy


Inflammatory anterior arch abnormalities


Inflammatory bowel disease


Inflammatory posterior arch abnormality


Interquartile range


Interspinous oedema


Low back pain


Magnetic resonance imaging


Non-steroidal anti-inflammatory drug


Pedicle oedema


Standard deviation


Spinous process oedema


Short-TI inversion recovery sequence


Tumour necrosis factor


Transverse process oedema


Visual analogue scale


Vertebral fat deposition



We are grateful to Dr. Helene Chiavassa and Dr. Lapègue for their useful advice on reading MRI scans and enrolling patients in the LBP group. We wish to thank all of the radiology technicians who adopted the standardised protocol for lumbar MRI scans and assisted with patient self-questionnaires.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Prof Adeline Ruyssen-Witrand.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

One of the authors (Delphine Nigon) has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• Case–control study

• Cross-sectional study

• Diagnostic study

• Observational

• Performed at one institution

Supplementary material

330_2019_6231_MOESM1_ESM.docx (31 kb)
ESM 1 (DOCX 30 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Hélène Braun
    • 1
  • Clément Geniez
    • 1
  • Yannick Degboe
    • 1
    • 2
  • Arnaud Constantin
    • 1
    • 2
  • Alain Cantagrel
    • 1
    • 2
  • Delphine Nigon
    • 1
  • Nicolas Sans
    • 3
  • Marie Faruch-Bilfeld
    • 3
  • Adeline Ruyssen-Witrand
    • 1
    • 4
    Email author
  1. 1.Centre de rhumatologie, CHU de ToulouseUniversité Paul Sabatier Toulouse IIIToulouseFrance
  2. 2.UMR 1043, InsermUniversité Paul Sabatier Toulouse IIIToulouseFrance
  3. 3.Centre de radiologie, CHU de ToulouseUniversité Paul Sabatier Toulouse IIIToulouseFrance
  4. 4.UMR 1027, InsermUniversité Paul Sabatier Toulouse IIIToulouseFrance

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