@article{21648,
  author = {Hancock M. and Steffens D. and Lin C and Petocz P. and Luque-Suarez A. and Magnussen J. and Maher C.},
  title = {Risk factors for a recurrence of low back pain},
  abstract = {<p>
BACKGROUND CONTEXT: The clinical importance of lumbar pathology identified on MRI remains unclear. It is plausible that pathology seen on MRI is a risk factor for a recurrence of low back pain (LBP); however, to our knowledge this has not been investigated by previous studies. PURPOSE: To investigate if lumbar pathology, identifiable on MRI, increases the risk of a recurrence of (LBP). DESIGN: Prospective inception cohort study with 1 year follow up. PATIENT SAMPLE: 76 people who had recovered from an episode of LBP within the previous 3 months. OUTCOME MEASURES: The primary outcome was time to recurrence of LBP which was determined by contacting participants at 2 month intervals for 12 months. METHODS: All participants underwent a baseline assessment including MRI scan and completion of a questionnaire which assessed a range of potential risk factors for recurrence. MRI scans were reported for the presence of a range of MRI findings. The primary analysis investigated the predictive value of 2 clinical features (age and number of previous episodes) and 6 MRI findings (disc degeneration, high intensity zone, Modic changes, disc herniation, facet joint arthrosis and spondylolisthesis) in a multivariate Cox regression model. We decided a priori that dichotomous predictors with hazard ratios (HR) of &gt; 1.5 or &lt;0.67 would be considered potentially clinically important and justify further investigation. RESULTS: Of the 8 predictors entered into the primary multivariate model, 3 (disc degeneration, high intensity zone and number of previous episodes) met our a priori threshold for potential importance. Participants with disc degeneration score &gt; 3 (Pfirrmann scale) had a hazard ratio (HR) of 1.89 (95% CI 0.42 to 8.53) compared to those without. Patients with high intensity zone had a HR of 1.84 (95% CI 0.94 to 3.59) compared to those without. For every additional previous episode participants had a HR of 1.04 (95% CI 1.02 to 1.07). CONCLUSIONS: We identified promising risk factors for a recurrence of LBP, which should be further investigated in larger trials. The findings suggest pathology seen on MRI plays a potentially important role in recurrence of LBP.
</p>
},
  year = {2015},
  journal = {Spine Journal},
  volume = {15},
  edition = {2015/07/15},
  pages = {2360-2368},
  isbn = {1878-1632 (Electronic)<br/>1529-9430 (Linking)},
  note = {Hancock, Mark<br/>Maher, Chris<br/>Petocz, Peter<br/>Lin, Chung-Wei Christine<br/>Steffens, Daniel<br/>Luque-Suarez, Alejandro<br/>Magnussen, John<br/>Spine J. 2015 Jul 10. pii: S1529-9430(15)00686-5. doi: 10.1016/j.spinee.2015.07.007.},
  language = {Eng},
}