Can MRI predict the future for low back pain patients?

A recent study sought to determine the extent to which degenerative disc changes in young low back pain patients predict progression of degenerative changes, disability, and pain 30 years later!

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STUDY: Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-Year Follow-up MRI Study. – Simo et al. May 2020

Study reviewed by Todd Hargrove

Key points from the study

• Decreased signal intensity of lumbar discs at baseline predicted severe degeneration at 30-year follow-up.
• The mean number of discs with degeneration increased from 0.9 to 3.5 per subject.
• Early disc degeneration did NOT predict future pain or disability.

Okay, let’s dive into it!

Background and Objective

MRI is an accurate method of measuring degenerative changes in intervertebral discs. The long-term consequences of such changes remain unclear however.

Methods/What They Did

In 1987, 75 low back pain patients aged 20 had lumbar spines MRIs. The subjects were all military recruits whose pain was severe enough to prevent service. 30 years later, 69 of these patients were contacted. Of these, 35 completed a pain and disability questionnaire, and 26 of these 35 received an MRI and clinical examination. MRIs were evaluated for decreased signal intensity and other degenerative changes.

Results/What They Found

Decreased signal intensity at baseline predicted severe degenerative change at follow up. For example, 57% of discs with decreased signal intensity at baseline had severely decreased signal intensity at follow-up, compared to 11% of healthy discs.

Importantly however, severity of disc degeneration at baseline was NOT associated with pain or disability at follow-up. The authors concluded that in young low back pain patients, early degeneration in lumbar discs predicts progressive degenerative change, but not pain or disability.

Limitations/Things to Keep in Mind

• Researchers did not have the MR images from the original study – only the values for signal intensity.
• The sample size was relatively small.
• Many subjects from the first study did not participate in the follow-up.

Clinical Implications

The long-term effects of early disc degeneration remain unclear. This study found that early disc degeneration in young low back pain patients was associated with severe changes after 30 years, but not pain or disability.

This study adds to a large and growing body of research showing that low back pain is complex, and that tissue damage is only one of many different factors that may contribute to pain. In fact, such damage may have little ability to predict the future course of events.

Tissue damage is only one of many different factors that may contribute to pain.

This study also presents encouraging evidence that 2/3 of a group of people with severe back pain in youth had only mild or no pain 30 years later. This information might benefit patients in reducing catastrophization, increasing optimism and self-efficacy, and informing decision-making about the need for potential surgery.