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 > 1.5 or <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 > 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.
AD - Faculty of Human Sciences, Macquarie University, Sydney Australia. Electronic address: mark.hancock@mq.edu.au.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 > 1.5 or <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 > 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.
PY - 2015 SN - 1878-1632 (Electronic)