Longitudinal associations between incident lumbar spine MRI findings and chronic low back pain or radicular symptoms: retrospective analysis of data from the longitudinal assessment of imaging and disability of the back (LAIDBACK)
1 Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA USA
2 Division of Rehabilitation Care Services, VA Puget Sound Health Care System, 1660 S. Columbian Way RCS-117 Seattle, WA, USA
3 Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA USA
4 Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
5 Department of Epidemiology, University of Washington School of Public Health, Seattle, WA USA
6 Department of Radiology, University of Washington School of Medicine, Seattle, WA USA
7 Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA USA
8 Department of Health Services, University of Washington School of Public Health, Seattle, WA USA
BMC Musculoskeletal Disorders 2014, 15:152 doi:10.1186/1471-2474-15-152Published: 13 May 2014
There are few longitudinal cohort studies examining associations between incident MRI findings and incident spine-related symptom outcomes. Prior studies do not discriminate between the two distinct outcomes of low back pain (LBP) and radicular symptoms. To address this gap in the literature, we conducted a secondary analysis of existing data from the Longitudinal Assessment of Imaging and Disability of the Back (LAIDBACK). The purpose of this study was to examine the association of incident lumbar MRI findings with two specific spine-related symptom outcomes: 1) incident chronic bothersome LBP, and 2) incident radicular symptoms such as pain, weakness, or sensation alterations in the lower extremity.
The original LAIDBACK study followed 123 participants without current LBP or sciatica, administering standardized MRI assessments of the lumbar spine at baseline and at 3-year follow-up, and collecting information on participant-reported spine-related symptoms and signs every 4 months for 3 years. These analyses examined bivariable and multivariable associations between incident MRI findings and symptom outcomes (LBP and radicular symptoms) using logistic regression.
Three-year cumulative incidence of new MRI findings ranged between 2 and 8%, depending on the finding. Incident annular fissures were associated with incident chronic LBP, after adjustment for prior back pain and depression (adjusted odds ratio [OR] 6.6; 95% confidence interval [CI] 1.2-36.9). All participants with incident disc extrusions (OR 5.4) and nerve root impingement (OR 4.1) reported incident radicular symptoms, although associations were not statistically significant. No other incident MRI findings showed large magnitude associations with symptoms.
Even when applying more specific definitions for spine-related symptom outcomes, few MRI findings showed large magnitude associations with symptom outcomes. Although incident annular fissures, disc extrusions, and nerve root impingement were associated with incident symptom outcomes, the 3-year incidence of these MRI findings was extremely low, and did not explain the vast majority of incident symptom cases.