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Not all parameters detect relationship between low back pain and MRI findings
ODI, VAS scores positively correlated with disc disease on MRI but two other scores did not.
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The first large-scale population study into wheter first-time low back pain correlates with MRI findings revealed that increased disc degeneration on MRI was directly related to how much back pain subjects reported.
In a related study the investigators conducted into how age-related degenerative spine changes can differ from degenerative disc disease (DDD), “We were able to demonstrate that when you have a more severe form of degeneration than expected for your age, you are much more likely to be symptomatic,” said Kenneth M.C. Cheung, MD, FRCS, lead investigator for both studies.
Discussing these findings with Orthopaedics Today International, Cheung said, “What we are suggesting is that although you can have MRI changes without symptoms, if you have significant changes on the MRI scans … it is very likely you will have symptoms.”
He presented results of both studies at the International Society for the Study of the Lumbar Spine 34th Annual Meeting.
Whole spine MRI
Cheung and colleagues included 1,043 subjects from southern China between the ages of 18 and 55 years who also underwent genetic evaluation for predisposition to back problems. A microsatellite marker analysis revealed the subjects were representative of the general population, he said.
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Cheung and co-investigator Jaro Karpinnen, MD, of Oulu, Finland, read each subject’s sagittal whole-spine MRI.
The physicians graded the severity of degeneration from 0 to 3 at each lumbar level, if any, using Schneiderman’s classification.
Calculating DDD score
The total of the level scores yielded the subject’s overall DDD score (<1 = nondegenerated, >1 to <4 = mildly degenerated, and >4 = moderate to severely degenerated lumbar spine).
Subjects also completed the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Roland Morris score (RM) and SF-36 low back pain (LBP) questionnaires, after which investigators attempted to correlate reported pain with MRI findings. Investigators said 525 subjects reported at least one LBP incident and 177 subjects had back pain at the time.
Those with back pain had increased degeneration with ODI and VAS scores that increased proportionately. However, their RM and SF-36 scores did not reflect the extent of their DDD.
“It’s difficult to say why this happened,” but differences between scoring systems are common, Cheung said. “I suppose it reflects on the make-up of the questionnaires, but we really haven’t looked at that in enough detail.
“Most people use more than one questionnaire probably for this reason,” he noted.
Potential of new therapies
Therapies now being researched — including cytokines, gene therapy and stem cells — may prove helpful for mitigating the effects of an accelerated degenerative cascade, Cheung told Orthopaedics Today International.
“This study lends ammunition to the fact that the more severe DDD you have, the more likely you are to have symptoms,” he said.
“I think that one thing that has come out of the many basic science studies is that physicians really need to address the issue of DDD early if they are to have any reasonable chance of success.”
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This 22-year-old woman’s one-level disc degeneration and herniation caused her mild back pain. Based on the MRI, the degenerative disc disease score was 2. | This patient’s DDD score was 13. He had multi-level degeneration that caused severe back pain. | The normal MRI in this 24-year-old man was associated with a lack of back pain and a DDD score of 0. Images: Cheung KMC |
For more information:Reference:
- Kenneth M.C. Cheung, MD, FRCS, can be reached in the department of orthopaedics and traumatology, Queen Mary Hospital, 102 Pakfulam Road, Hong Kong, SAR, China. +852-2855-4254; e-mail: ken-cheung@hku.hk. He has no financial conflicts to disclose.
- Cheung KMC, Karppinen J, Guo GG, et al. Relationship between MRI changes of the lumbar spine and low back pain: an MRI study of 1,043 population-based subjects. #1. Cheung KMC, Fan BJ, Karpinnen J, et al. Can age-related intervertebral disc changes be differentiated from degenerative disc disease? #21. Both presented at the International Society for the Study of the Lumbar Spine 34th Annual Meeting. June 10-14, 2007. Hong Kong.