Comparison between pain at discography and morphological disc changes at axial loaded MRI in patients with low back pain

Hebelka, Hanna; Brisby, Helena; Hansson, Tommy

doi:10.1007/s00586-014-3408-6

Cited by 16 publications

(11 citation statements)

References 48 publications

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“…The distinct responses induced with alMRI makes the combination of quantitative MRI and alMRI a promising method to assess behavioral EP characteristics clinically. In addition, alMRI offers a method to image the spine in a position inducing concordant pain in LBP patients [ 34 ]. To elucidate if the differences in EPZ characteristics between unloaded MRI and alMRI represent altered diffusion/perfusion, future studies are encouraged to include diffusion-weighted sequences.…”

Section: Discussionmentioning

confidence: 99%

Axial loading during MRI induces significant T2 value changes in vertebral endplates—a feasibility study on patients with low back pain

et al. 2018

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Background: The function of the endplate (EP) is the most important factor influencing nutritional supply to the avascular intervertebral disc (IVD). It is desired to have a non-invasive method to assess functional EP characteristics in vivo. Assessment of functional EP characteristics is important in order to understand its relation to IVD degeneration, which in turn might deepen the understanding of the pathophysiology behind low back pain (LBP). It was hypothesized that, by comparing quantitative MRI of EPs performed with conventional supine MRI (unloaded MRI) with axial loading during MRI (alMRI), dynamical properties of the EP can be displayed. The aim was therefore to investigate the feasibility of axial loading during MRI (alMRI) to instantaneously induce quantitative EP changes. Methods: T2 mapping of 55 vertebral EPs (L1-S1) in five LBP patients was performed during conventional supine MRI (unloaded MRI) and subsequent alMRI. With T2 mapping, the cartilaginous EP and bony EP cannot be separated; hence, the visualized EP was termed EP zone (EPZ). Each EPZ was segmented at multiple midsagittal views, generating volumetric regions of interest. EPZs demonstrating signal inhomogeneity and/or adjacent Modic changes (MC) were termed abnormal EPZs. EPZ mean T2 values were compared between unloaded MRI and alMRI, and their relationship with abnormal EPZs was determined. Results: alMRI induced significantly higher (p = 0.01) EPZ mean T2 values compared with unloaded MRI. Significantly higher mean T2 values were seen in inferior EPZs compared with superior EPZs, both with unloaded MRI (35%, p < 0.001) and with alMRI (26%, p = 0.04). Significant difference between unloaded MRI and alMRI was seen in normal (p = 0.02), but not in abnormal EPZs (p = 0.5; n = 12). Conclusions: alMRI induces changes in human EPZ characteristics in vivo. The T2 value significantly increased in normal EPZs, with lack of such in abnormal EPZs. Combining T2 mapping with alMRI provides a clinical feasible, non-invasive method with potential to reveal biochemical behavioral patterns, thus adding another dimension of the EPZs characteristics compared with information obtained with solely unloaded MRI.

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Section: Discussionmentioning

confidence: 99%

Axial loading during MRI induces significant T2 value changes in vertebral endplates—a feasibility study on patients with low back pain

et al. 2018

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“…Discogenic pain has been suggested to be rather a symptom in patients with different stages of spinal impairment than one entity or diagnosis [4]. In the previous MRI studies, different gradings for degenerative findings have been used, linear associations with LBP have been assumed, and single MRI findings have been studied instead of clusters of findings together to find predictors for LBP [3].…”

Section: Introductionmentioning

confidence: 99%

Chronic low back pain in relation to Modic changes, bony endplate lesions, and disc degeneration in a prospective MRI study

et al. 2016

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Purpose To clarify the significance of Modic changes, bony endplate lesions, and disc degeneration as predictors of chronic low back pain (LBP) during 1-year follow-up. Methods 49 patients with severe, non-specific, chronic LBP, and Modic 1 lesion (M1) were prospectively studied with MRI and questionnaire. Changes in grade of disc degeneration, severity of Modic changes, Schmorl lesions, and bony endplate irregularities were evaluated and changes assessed in LBP intensity on numeric rating scale 0-10 and severity with Oswestry disability index 0-100 (ODI). Association between change in MRI findings and symptoms was computed using generalized estimating equations analysis.Results Although pain decreased in most patients during 1-year follow-up, it increased or persisted in 36 %. Change in M1, M2, bony endplate lesions, and signal intensity (SI) and height of the disc associated with change of pain intensity, while change in M1, bony endplate lesions, and disc height associated with change of ODI. Not only persistent M1s, increasing bony endplate lesions, decreasing disc height, and M2s, but also new M2s predicted persistence of pain, while decrease of M1s and SI of the disc and increase of size of M2s predicted decrease of pain. Changes in disc bulges did not associate with pain. Conclusions In patients with chronic non-specific LBP, persisting M1, decreasing disc height, and increasing bony endplate lesions associated with persisting pain while decrease of SI of the disc with decrease of pain. Such changing MRI findings in the same disc space have earlier been shown to progress abnormally fast. They may be signs or biomarkers of a prolonged pain causing, deforming degenerative process, and should lead to considering early intervention or specific treatments to affect that process.

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“…Therefore, with an increase in demand, a noninvasive, less expensive, and simple screening diagnostic method seems to be necessary. Many studies have shown that reduced disc height is associated with disc degeneration in the lumbar spine (39,40); thus, we suggest US as an accessible alternative for disc height evaluation, especially when a discogenic condition is suspected.…”

Section: Disc Height Measurementmentioning

confidence: 93%

Suggested Applications of Musculoskeletal Ultrasound to Identify the Etiologies of Low Back Pain

Noormohammadpour¹,

Amiri²,

Moghadam³

2022

Asian J Sports Med

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Comparison between pain at discography and morphological disc changes at axial loaded MRI in patients with low back pain

Cited by 16 publications

References 48 publications

Axial loading during MRI induces significant T2 value changes in vertebral endplates—a feasibility study on patients with low back pain

Axial loading during MRI induces significant T2 value changes in vertebral endplates—a feasibility study on patients with low back pain

Chronic low back pain in relation to Modic changes, bony endplate lesions, and disc degeneration in a prospective MRI study

Suggested Applications of Musculoskeletal Ultrasound to Identify the Etiologies of Low Back Pain

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