Ole Kudsk Jensen1, Claus Vinther Nielsen2, Joan Solgaard Sørensen3, Kristian Stengaard-Pedersen4. 1. The Spine Center, Diagnostic Center, Silkeborg Regional Hospital, Falkevej 1-3, 8600 Silkeborg, Denmark. Electronic address: olejesen@rm.dk. 2. Section of Clinical Social Medicine and Rehabilitation, Institute of Public Health, University of Aarhus, P.P. Ørumsgade 11, 8000 Aarhus C, Denmark. 3. Associated to Research Department, Spine Centre of Southern Denmark, Lillebaelt Hospital, Østre Hougvej 55, 5500 Middelfart, Denmark. 4. Department of Rheumatology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
Abstract
BACKGROUND CONTEXT: It is not clear whether Modic changes (MC) is associated with low back pain (LBP) outcome. PURPOSE: To study associations between baseline degenerative manifestations and outcome in sick-listed LBP patients. STUDY DESIGN: Prospective nested cohort study based on a randomized controlled trial. PATIENT SAMPLE: Out of 325 sick-listed LBP patients, 141 were consecutively examined by magnetic resonance imaging (MRI) and included and 140 completed the study. OUTCOME MEASURES: Degenerative manifestations of the lumbar spine were quantified; associations were studied in relation to the three primary outcomes: change of back+leg pain, change of function as measured by Roland-Morris questionnaire, and 1-year unsuccessful return to work (U-RTW). METHODS: By using a previously validated MRI protocol, a specialist in radiology, who had no access to clinical data, described the images. Associations were studied by linear and logistic regression with adjustment for previously identified prognostic factors for 1-year pain and function and for U-RTW. RESULTS: Clinically, 43% of the patients had radiculopathy. Degenerative changes were prevalent with altered disc contours in 84%, high-intensity zones in 70%, and nerve root touch or impingement in 63% of the patients. MC was identified in 60% of the patients, 18% with Type 1 changes and 42% with Type 2 changes, Type 1 including both Type 1 and Type 1 in combination with Type 2. Patients with Type 1 changes reported more back pain and did not improve in pain or disability. They increased to include 30% of the patients with U-RTW at 1 year. Patients with Type 2 changes did not differ significantly from patients without MC but differed significantly from patients with Type 1 changes in all three outcomes. Other degenerative manifestations were not significantly associated with any of the three outcomes. CONCLUSIONS: The only degenerative manifestation negatively associated with outcome was Type 1 MC that affected 18% of the cohort at baseline and implied an increased risk for no improvement in pain and function and for U-RTW, even after adjustment for other prognostic factors.
RCT Entities:
BACKGROUND CONTEXT: It is not clear whether Modic changes (MC) is associated with low back pain (LBP) outcome. PURPOSE: To study associations between baseline degenerative manifestations and outcome in sick-listed LBP patients. STUDY DESIGN: Prospective nested cohort study based on a randomized controlled trial. PATIENT SAMPLE: Out of 325 sick-listed LBP patients, 141 were consecutively examined by magnetic resonance imaging (MRI) and included and 140 completed the study. OUTCOME MEASURES: Degenerative manifestations of the lumbar spine were quantified; associations were studied in relation to the three primary outcomes: change of back+leg pain, change of function as measured by Roland-Morris questionnaire, and 1-year unsuccessful return to work (U-RTW). METHODS: By using a previously validated MRI protocol, a specialist in radiology, who had no access to clinical data, described the images. Associations were studied by linear and logistic regression with adjustment for previously identified prognostic factors for 1-year pain and function and for U-RTW. RESULTS: Clinically, 43% of the patients had radiculopathy. Degenerative changes were prevalent with altered disc contours in 84%, high-intensity zones in 70%, and nerve root touch or impingement in 63% of the patients. MC was identified in 60% of the patients, 18% with Type 1 changes and 42% with Type 2 changes, Type 1 including both Type 1 and Type 1 in combination with Type 2. Patients with Type 1 changes reported more back pain and did not improve in pain or disability. They increased to include 30% of the patients with U-RTW at 1 year. Patients with Type 2 changes did not differ significantly from patients without MC but differed significantly from patients with Type 1 changes in all three outcomes. Other degenerative manifestations were not significantly associated with any of the three outcomes. CONCLUSIONS: The only degenerative manifestation negatively associated with outcome was Type 1 MC that affected 18% of the cohort at baseline and implied an increased risk for no improvement in pain and function and for U-RTW, even after adjustment for other prognostic factors.
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