This article is more than 5 years old. Information may no longer be current.
Underlying spine pathology seen on imaging affects nonoperative LBP care
Click Here to Manage Email Alerts
SCOTTSDALE, U.S.A. — Combined data from a randomized controlled trial and a prospective cohort study presented here highlight the role of underlying spine pathology in the clinical outcomes of guideline-based care for patients with acute low back pain.
“The presence and type of underlying spine pathology does affect the outcome of nonoperative clinical guideline-based treatment for acute lower back pain,” Brian Arthur, DC, MSc, of the International Collaboration on Repair Discoveries and the University of British Columbia in Vancouver, Canada, said at the International Society for the Study of the Lumbar Spine Meeting.
“Patients with no identifiable pathology improve the most, while patients with underlying disc degeneration improve the least. In the future, outcome studies of acute lower back pain should control for the presence of diagnostic imaging-identified underlying spine pathology,” he said.
Imaging, scans, medial branch blocks used
The research team, which included principal investigator Jeffrey Quon, DC, MHSc, PhD, FCCSC, and Paul Bishop, DC, MD, PhD, studied 97 adults with Quebec Task Force grade I or II acute low back pain (LBP) without radiculopathy whose pain lasted less than 4 weeks. None of the patients enrolled in the study had “red flag” conditions, such as nerve deficits, and none had worker’s compensation or motor vehicle insurance claims, Arthur said.
Using plain film radiographs, CT, MRI, bone scans, and medial branch blocks, the investigators categorized the patients as having spinal stenosis, facet arthropathy, Thompson grade 3 or higher disc degeneration or no underlying, identifiable pathology.
The primary outcome measure for the study was a Roland-Morris score change from baseline to 24 weeks. Secondary measures included changes in physical function and bodily pain.
Similar baseline demographics, Roland-Morris scores
Arthur and colleagues found no significant differences between the groups for baseline demographics, or the Roland-Morris bodily pain or physical function scores.
“Regarding Roland-Morris scores, significant differences between groups were observed at all time points and especially at 24 weeks,” Arthur said. “Patients with the least pathology or no pathology improved the most, whereas those with disc degeneration and multiple pathologies improved the least.”
The study also revealed significant differences in physical function at 24 weeks between the ‘no pathology’ and disc degeneration groups.
“Regarding general bodily pain, there were significant differences observed at all time points — 8 [weeks], 16 [weeks] and 24 weeks,” Arthur said.
“The surgical approach to treating spine disorders is based upon treating specific pathology, while the nonoperative treatment approach is, with a few notable exceptions (e.g., image-guided spine interventions), most commonly generic and makes little or no attempt to consider a tissue-specific diagnosis (e.g., advanced disc degeneration or facet arthropathy),” Arthur told Orthopaedics Today Europe. “The clinical significance of this study is that it demonstrates that underlying spine pathology is a significant predictor of the clinical outcome of the current gold standard of nonoperative treatment for patient with acute LBP,” Arthur said. – by Gina Brockenbrough, MS
- Reference:
- Arthur B. Paper #2. Presented at: International Society for the Study of the Lumbar Spine Meeting; May 13-17, 2013, Scottsdale, Ariz., USA.
- For more information:
- Brian Arthur, DC, MSc, can be reached at ICORD Spine Centre, Blusson Pavilion, 6100-818 West 10th Ave., Vancouver, BC V5Z 1M9 Canada; email: brian.arthur@telus.net.
Disclosure: Arthur, Bishop and Quon have no relevant financial disclosures.