Do more MRI findings imply worse disability or more intense low back pain? A cross-sectional study of candidates for lumbar disc prosthesis

Abstract

Objective

To examine whether combined magnetic resonance imaging (MRI) findings are related to the degree of disability and low back pain (LBP) in candidates for lumbar disc prosthesis surgery.

Materials and methods

This cross-sectional study included 170 disc prosthesis candidates (mean age 41 years; 88 women) with chronic non-radicular LBP and localized disc degeneration. Experienced radiologists rated Modic changes and disc findings at L4-S1 on pre-treatment MRIs. An MRI total score (0–10) for findings at L4/L5 plus L5/S1 was calculated for Modic type I and/or II changes, a posterior high intensity zone (HIZ) in the disc, dark/black nucleus pulposus signal, and ≥40 % disc height decrease. We analyzed the relationship of the MRI total score to the Oswestry Disability Index (ODI) (n = 170) and LBP intensity scores (0–100 visual analogue scale, n = 165) using multiple linear regression and adjusting for age, gender, body mass index, smoking, and anxiety/depression.

Results

The MRI total score was not related to ODI (regression coefficient 0.12, p = 0.79) or LBP intensity (regression coefficient 0.64, p = 0.37). When individual MRI findings were analyzed, patients with HIZ at L5/S1 had slightly lower ODI scores (4.7 points, p = 0.02). In post hoc analyses, results remained unchanged after adding facet arthropathy to the MRI total score and adjusting also for physical workload and physical leisure-time activity.

Conclusions

The combined MRI findings were not related to the degree of disability or the intensity of LBP. These degenerative MRI findings cannot explain variation in pre-treatment disability and pain in patients with chronic LBP accepted for disc prosthesis surgery.

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Acknowledgments

We want to thank the patients participating in this study.

Conflict of interest

The authors declare that they have no conflicts of interest.

Financial support

Financial support for this study was received from the Western and South Eastern Norway Regional Health Authorities, from Haakon and Sigrun Ødegaard’s fund at the Norwegian Society of Radiology, and from the Norwegian ExtraFoundation for Health and Rehabilitation, through the Norwegian Back Pain Association.

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Corresponding author

Correspondence to Ansgar Espeland.

Additional information

Additional investigators of the Norwegian Spine Study Group who participated in the study are listed in the ‘‘Appendix.’’

The following additional investigators participated in the study:

From the University Hospital North Norway, Tromsø (included n = 8 patients): Department of Orthopaedic Surgery: Odd-Inge Solem, MD; Department of Neurosurgery: Jens Munch-Ellingsen, MD, PhD; and Department of Physical Medicine and Rehabilitation: Franz Hintringer, MD, Anita Dimmen Johansen, Ergonomist, Guro Kjos, PT. From Trondheim University Hospital, Trondheim (included n = 21 patients): National Centre for Spinal Disorders, Department of Neurosurgery: Hege Andresen, RN, Øystein P Nygaard, MD, Professor, Ivar Rossvoll, MD, PhD, Helge Rønningen, MD, Professor, Kjell Arne Kvistad, MD, PhD; and Multidiscipline Spinal Unit, Dep. of Physical Medicine and Rehabilitation: Bjørn Skogstad, MD, Janne Birgitte Børke, PT, MSc, Erik Nordtvedt, PT, Gunnar Leivseth, MD, Professor, Magne Rø, MD. From Haukeland University Hospital, Bergen (included n = 64 patients): Kysthospitalet in Hagevik, Department of Orthopedic Surgery: Sjur Braaten, MD, Turid Rognsvåg, PT, MSc, Gunn Odil Hirth Moberg, Secretary; and The Outpatient Spine Clinic, Department of Physical Medicine and Rehabilitation: Jan Sture Skouen, MD, Professor, Lars Geir Larsen, PT, Vibeche Iversen, RN, Ellen H Haldorsen, PhD, Cand Psychol, Elin Karin Johnsen, RN, Kristin Hannestad, PT. From Stavanger University Hospital, Stavanger (included n = 27 patients): Department of Orthopaedic Surgery: Endre Refsdal, MD. From Oslo University Hospital, Oslo (included n = 53 patients): Department of Orthopaedics: Vegard Slettemoen, RN, Kenneth Nilsen, RN, Kjersti Sunde, RN, Helenè E Skaara, PT, MSc; and Department of Physical Medicine and Rehabilitation: Berit Johannessen, PT, Anna Maria Eriksdotter, PT, MSc, Anne Keller, MD, PhD.

Appendix

Appendix

From University Hospital North Norway, Tromsø (included n = 8 patients): Department of Orthopedic Surgery: Odd-Inge Solem, MD, Department of Neurosurgery: Jens Munch-Ellingsen, MD, PhD, and from Department of Physical Medicine and Rehabilitation Franz Hintringer, MD, Anita Dimmen Johansen, ergonomist, Guro Kjos, PT. From Trondheim University Hospital, Trondheim (included n = 21 patients): National centre for spinal disorders, Department of Neurosurgery: Øystein P Nygaard, PhD, Hege Andresen, RN, Helge Rønningen, MD, Professor, Kjell Arne Kvistad, MD, PhD, and from Multidiscipline spinal unit, Dep. of Physical Medicine and Rehabilitation; Bjørn Skogstad, MD, Janne Birgitte Børke, PT, MSc, Erik Nordtvedt, PT, Magne Rø, MD, Gunnar Leivseth, MD, Professor. From Haukeland University Hospital, Bergen (included n = 64 patients): Kysthospitalet in Hagevik, Department of Orthopedic Surgery: Sjur Braaten, MD, Turid Rognsva°g, PT, MSc, Gunn Odil Hirth Moberg, secretary, and From The Outpatient Spine Clinic. Department of Physical Medicine and Rehabilitation: Lars Geir Larsen, PT, Vibeche Iversen, RN, Ellen H Haldorsen, cand, psychol, PhD, Elin Karin Johnsen, RN, Kristin Hannestad, PT; From Stavanger University Hospital, Stavanger (included n = 27 patients): Department of Orthopedic Surgery: Endre Refsdal, MD. From Oslo University Hospital, Oslo (included n = 53 patients): Department of Orthopaedics: Vegard Slettemoen, RN, Kenneth Nilsen, RN, Kjersti Sunde, RN, Helenè E Skaara, PT, MSc, and from Department of Physical Medicine and Rehabilitation: Anne Keller, MD, PhD, Berit Johannessen, PT, Anna Maria Eriksdotter, PT, MSc.

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Berg, L., Hellum, C., Gjertsen, Ø. et al. Do more MRI findings imply worse disability or more intense low back pain? A cross-sectional study of candidates for lumbar disc prosthesis. Skeletal Radiol 42, 1593–1602 (2013). https://doi.org/10.1007/s00256-013-1700-x

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Keywords

  • Back pain
  • Disc degeneration
  • Magnetic resonance imaging
  • Spine