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.
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.
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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Emch TM, Modic MT. Imaging of lumbar degenerative disk disease: history and current state. Skeletal Radiol. 2011;40:1175–89.
Chou D, Samartzis D, Bellabarba C, et al. Degenerative magnetic resonance imaging changes in patients with chronic low back pain: a systematic review. Spine. 2011;36:S43–53 (Phila Pa 1976).
Jensen TS, Karppinen J, Sorensen JS, Niinimaki J, Leboeuf-Yde C. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J. 2008;17:1407–22.
Endean A, Palmer KT, Coggon D. Potential of magnetic resonance imaging findings to refine case definition for mechanical low back pain in epidemiological studies: a systematic review. Spine. 2011;36:160–9 (Phila Pa 1976).
Mariconda M, Galasso O, Imbimbo L, Lotti G, Milano. Relationship between alterations of the lumbar spine, visualized with magnetic resonance imaging, and occupational variables. Eur Spine J. 2007;16:255–66.
Arana E, Marti-Bonmati L, Vega M, et al. Relationship between low back pain, disability, MR imaging findings and health care provider. Skeletal Radiol. 2006;35:641–7.
Modic MT, Ross JS. Lumbar degenerative disk disease. Radiology. 2007;245:43–61.
Blumenthal S, McAfee PC, Guyer RD, et al. A prospective, randomized, multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part I: evaluation of clinical outcomes. Spine. 2005;30:1565–75; discussion E387–91 (Phila Pa 1976).
Berg S, Tullberg T, Branth B, Olerud C, Tropp H. Total disc replacement compared to lumbar fusion: a randomised controlled trial with 2-year follow-up. Eur Spine J. 2009;18:1512–9.
Hellum C, Johnsen LG, Storheim K, et al. Surgery with disc prosthesis versus rehabilitation in patients with low back pain and degenerative disc: two-year follow-up of randomised study. BMJ 2011;342:d2786 doi:10.1136/bmj.d2786
Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976) 2000;25:2940–2952; discussion 2952.
American College of Radiology (ACR), American Society of Neuroradiology (ASNR), Society of Computed Body Tomography and Magnetic Resonance (SCBT-MR). ACR-ASNR-SCBT-MR Practice Guideline for the Performance of Magnetic Resonance imaging (MRI) of the Adult Spine. Resolution 15. 2012. http://www.asnr.org/sites/default/files/guidelines/MRI_Adult_Spine.pdf Accessed 9 July 2013.
Carrino JA, Morrison WB. Imaging of lumbar degenerative disc disease. Semin Spine Surg. 2003;15:361–83.
Berg L, Neckelmann G, Gjertsen Ø, et al. Reliability of MRI findings in candidates for lumbar disc prosthesis. Neuroradiology. 2012;54:699–707. doi:10.1007/s00234-011-0963-y
Jensen TS, Sorensen JS, Kjaer P. Intra- and interobserver reproducibility of vertebral endplate signal (Modic) changes in the lumbar spine: the Nordic Modic Consensus Group classification. Acta Radiol. 2007;48:748–54.
Fardon DF, Milette PC. Nomenclature and classification of lumbar disc pathology. Recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine. 2001;26:E93–E113 (Phila Pa 1976).
Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166:193–9.
Carrino JA, Lurie JD, Tosteson AN, et al. Lumbar spine: reliability of MR imaging findings. Radiology. 2009;250:161–70.
Aprill C, Bogduk N. High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br J Radiol. 1992;65:361–9.
Luoma K, Riihimaki H, Luukkonen R, Raininko R, Viikari-Juntura E, Lamminen A. Low back pain in relation to lumbar disc degeneration. Spine. 2000;25:487–92 (Phila Pa 1976).
Solgaard Sorensen J, Kjaer P, Jensen ST, Andersen P. Low-field magnetic resonance imaging of the lumbar spine: reliability of qualitative evaluation of disc and muscle parameters. Acta Radiol. 2006;47:947–53.
Raininko R, Manninen H, Battie MC, Gibbons LE, Gill K, Fisher LD. Observer variability in the assessment of disc degeneration on magnetic resonance images of the lumbar and thoracic spine. Spine. 1995;20:1029–35 (Phila Pa 1976).
Videman T, Battie MC, Gibbons LE, Maravilla K, Manninen H, Kaprio J. Associations between back pain history and lumbar MRI findings. Spine. 2003;28:582–8 (Phila Pa 1976).
Masharawi Y, Kjaer P, Bendix T, et al. The reproducibility of quantitative measurements in lumbar magnetic resonance imaging of children from the general population. Spine. 2008;33:2094–100 (Phila Pa 1976).
Fujiwara A, Tamai K, Yamato M, et al. The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J. 1999;8:396–401.
Kjaer P, Leboeuf-Yde C, Korsholm L, Sorensen JS, Bendix T. Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine. 2005;30:1173–80 (Phila Pa 1976).
Grotle M, Brox JI, Vollestad NK. Cross-cultural adaptation of the Norwegian versions of the Roland-Morris Disability Questionnaire and the Oswestry Disability Index. J Rehabil Med. 2003;35:241–7.
Smeets R, Koke A, Lin CW, Ferreira M, Demoulin C. Measures of function in low back pain/disorders: Low Back Pain Rating Scale (LBPRS), Oswestry Disability Index (ODI), Progressive Isoinertial Lifting Evaluation (PILE), Quebec Back Pain Disability Scale (QBPDS), and Roland-Morris Disability Questionnaire (RDQ). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S158–73.
Leren P, Askevold EM, Foss OP, et al. The Oslo study. Cardiovascular disease in middle-aged and young Oslo men. Acta Med Scand Suppl. 1975;588:1–38.
Browner WS, Newman TB, Hulley SB. Estimating sample size and power: applications and examples. In: Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB, editors. Designing clinical research. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 65–94.
Bendix T, Sorensen JS, Henriksson GA, Bolstad JE, Narvestad EK, Jensen TS. Lumbar Modic changes—a comparison between findings at low- and high-field magnetic resonance imaging. Spine. 2012;37:1756–62 (Phila Pa 1976).
Bankier AA, Levine D, Halpern EF, Kressel HY. Consensus interpretation in imaging research: is there a better way? Radiology. 2010;257:14–7.
Espeland A, Vetti N, Krakenes J. Are two readers more reliable than one? A study of upper neck ligament scoring on magnetic resonance images. BMC Med Imaging. 2013;13:4.
Jarvik JG, Deyo RA. Moderate versus mediocre: the reliability of spine MR data interpretations. Radiology. 2009;250:15–7.
Newman TB, Browner WS, Hulley SB. Enhancing causal interference in observational studies. In: Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB, editors. Designing clinical research. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 127–46.
Battie MC, Videman T, Kaprio J, et al. The twin spine study: contributions to a changing view of disc degeneration. Spine J. 2009;9:47–59.
Battie MC, Videman T. Lumbar disc degeneration: epidemiology and genetics. J Bone Joint Surg Am. 2006;88 Suppl 2:3–9.
Carragee EJ, Alamin TF, Miller JL, Carragee JM. Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine J. 2005;5:24–35.
Samartzis D, Karppinen J, Chan D, Luk KD, Cheung KM. The association of lumbar intervertebral disc degeneration on magnetic resonance imaging with body mass index in overweight and obese adults: a population-based study. Arthritis Rheum. 2012;64:1488–96.
Takatalo J, Karppinen J, Niinimaki J, et al. Does lumbar disc degeneration on magnetic resonance imaging associate with low back symptom severity in young Finnish adults? Spine. 2011;36:2180–9 (Phila Pa 1976).
Landmark T, Romundstad P, Borchgrevink PC, Kaasa S, Dale O. Associations between recreational exercise and chronic pain in the general population: evidence from the HUNT 3 study. Pain. 2011;152:2241–7.
Kirkwood BR, Sterne JAC. Regression modelling. In: Kirkwood BR, Sterne JAC, editors. Essential medical statistics. Oxford: Blackwell Publishing Ltd; 2003. p. 315–42.
Siepe CJ, Zelenkov P, Sauri-Barraza JC, et al. The fate of facet joint and adjacent level disc degeneration following total lumbar disc replacement: a prospective clinical, X-ray, and magnetic resonance imaging investigation. Spine. 2010;35:1991–2003 (Phila Pa 1976).
McAfee PC. The indications for lumbar and cervical disc replacement. Spine J. 2004;4:177S–81S.
Sheehan NJ. Magnetic resonance imaging for low back pain: indications and limitations. Ann Rheum Dis. 2010;69:7–11.
Gibson JN, Waddell G. Surgery for degenerative lumbar spondylosis: updated Cochrane Review. Spine. 2005;30:2312–20 (Phila Pa 1976).
Kleinstuck F, Dvorak J, Mannion AF. Are “structural abnormalities” on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic nonspecific low back pain? Spine. 2006;31:2250–7 (Phila Pa 1976).
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 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.
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.
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
- Back pain
- Disc degeneration
- Magnetic resonance imaging