Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
STUDY DESIGN: Prospective cohort study of randomly selected Veterans Affairs out-patients without baseline low back pain (LBP).
OBJECTIVE: To determine predictors of new LBP as well as the 3-year incidence of magnetic resonance imaging (MRI) findings.
SUMMARY OF BACKGROUND DATA: Few prospective studies have examined clinical and anatomic risk factors for the development of LBP, or the incidence of new imaging findings and their relationship to back pain onset.
METHODS: We randomly selected 148 Veterans Affairs out-patients (aged 35 to 70) without LBP in the past 4 months. We compared baseline and 3-year lumbar spine MRI. Using data collected every 4 months, we developed a prediction model of back pain-free survival.
RESULTS: After 3 years, 131 subjects were contacted, and 123 had repeat MRI. The 3-year incidence of pain was 67% (88 of 131). Depression had the largest hazard ratio (2.3, 95% CI = 1.2-4.4) of any baseline predictor of inci-dent back pain. Among baseline imaging findings, central spinal stenosis and nerve root contact had the highest, though nonsignificant, hazard ratios. We did not find an association between new LBP and type 1 endplate changes, disc degeneration, annular tears, or facet degeneration. The incidence of new MRI findings was low, with the most common new finding being disc signal loss in 11 (9%) subjects. All five subjects with new disc extrusions and all four subjects with new nerve root impingement had new pain.
CONCLUSION: Depression is an important predictor of new LBP, with MRI findings likely less important. New imaging findings have a low incidence; disc extrusions and nerve root contact may be the most important of these findings.
related content
- “The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects,” Borenstein et al, Journal of Bone & Joint Surgery (American), 2001.
- “Prospective controlled study of the development of lower back pain in previously asymptomatic subjects undergoing experimental discography,” Carragee et al, Spine (Phila Pa 1976), 2004.
- “The Twin Spine Study: contributions to a changing view of disc degeneration,” Battié et al, Spine J, 2009.
- “Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations,” Brinjikji et al, AJNR Am J Neuroradiol, 2015.
- “MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis,” Brinjikji et al, AJNR Am J Neuroradiol, 2015.
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