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Prevalence of degenerative and spondyloarthritis-related magnetic resonance imaging findings in the spine and sacroiliac joints in patients with persistent low back pain

  • Musculoskeletal
  • Published:
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Abstract

Objective

To estimate the prevalence of degenerative and spondyloarthritis (SpA)-related magnetic resonance imaging (MRI) findings in the spine and sacroiliac joints (SIJs) and analyse their association with gender and age in persistent low back pain (LBP) patients.

Methods

Degenerative and SpA-related MRI findings in the whole spine and SIJs were evaluated in Spine Centre patients aged 18–40 years with LBP.

Results

Among the 1,037 patients, the prevalence of disc degeneration, disc contour changes and vertebral endplate signal (Modic) changes were 87 % (±SEM 1.1), 82 % (±1.2) and 48 % (±1.6). All degenerative spinal findings were most frequent in men and patients aged 30–40 years. Spinal SpA-related MRI findings were rare. In the SIJs, 28 % (±1.4) had at least one MRI finding, with bone marrow oedema being the most common (21 % (±1.3)). SIJ erosions were most prevalent in patients aged 18–29 years and bone marrow oedema in patients aged 30–40 years. SIJ sclerosis and fatty marrow deposition were most common in women. SIJ bone marrow oedema, sclerosis and erosions were most frequent in women indicating pregnancy-related LBP.

Conclusion

The high prevalence of SIJ MRI findings associated with age, gender, and pregnancy-related LBP need further investigation of their clinical importance in LBP patients.

Key Points

• The location of vertebral endplate signal changes supports a mechanical aetiology.

• Several sacroiliac joint findings were associated with female gender and pregnancy-related back pain.

• Sacroiliac joint bone marrow oedema was frequent and age-associated, indicating a possible degenerative aetiology.

• More knowledge of the clinical importance of sacroiliac joint MRI findings is needed.

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Abbreviations

ASAS:

Assessment of SpondyloArthritis international Society

LBP:

Low back pain

MRI:

Magnetic resonance imaging

SEM:

Standard error of the mean

SIJ:

Sacroiliac joint

SpA:

Spondyloarthritis

SPIR:

Spectral pre-saturation with inversion recovery

STIR:

Sagittal short-tau inversion recovery

TSE:

Turbo spin-echo

VISTA:

Volume ISotropic T2-weighted Acquisition

References

  1. Deyo RA, Rainville J, Kent DL (1992) What can the history and physical examination tell us about low back pain? JAMA 268:760–765

    Article  CAS  PubMed  Google Scholar 

  2. Chou D, Samartzis D, Bellabarba C et al (2011) Degenerative magnetic resonance imaging changes in patients with chronic low back pain: a systematic review. Spine (Phila Pa 1976) 36:S43–S53

    Article  Google Scholar 

  3. Arnbak B, Leboeuf-Yde C, Jensen TS (2012) A systematic critical review on MRI in spondyloarthritis. Arthritis Res Ther 14:R55

    Article  PubMed  PubMed Central  Google Scholar 

  4. De Rycke L, Maas M, Tak PP, Baeten D (2010) 'MRI-tis' in the early diagnosis of axial SpA: issues and limitations. Nat Rev Rheumatol 6:666–669

    Article  PubMed  Google Scholar 

  5. Weber U, Zubler V, Zhao Z et al (2014) Does spinal MRI add incremental diagnostic value to MRI of the sacroiliac joints alone in patients with non-radiographic axial spondyloarthritis? Ann Rheum Dis

  6. Marzo-Ortega H, McGonagle D, O'Connor P et al (2009) Baseline and 1-year magnetic resonance imaging of the sacroiliac joint and lumbar spine in very early inflammatory back pain. Relationship between symptoms, HLA-B27 and disease extent and persistence. Ann Rheum Dis 68:1721–1727

    Article  CAS  PubMed  Google Scholar 

  7. Weber U, Lambert RG, Ostergaard M, Hodler J, Pedersen SJ, Maksymowych WP (2010) The diagnostic utility of magnetic resonance imaging in spondylarthritis: an international multicenter evaluation of one hundred eighty-seven subjects. Arthritis Rheum 62:3048–3058

    Article  PubMed  Google Scholar 

  8. Aydin SZ, Maksymowych WP, Bennett AN, McGonagle D, Emery P, Marzo-Ortega H (2012) Validation of the ASAS criteria and definition of a positive MRI of the sacroiliac joint in an inception cohort of axial spondyloarthritis followed up for 8 years. Ann Rheum Dis 71:56–60

    Article  PubMed  Google Scholar 

  9. Hermann KG, Baraliakos X, van der Heijde DM et al (2012) Descriptions of spinal MRI lesions and definition of a positive MRI of the spine in axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI study group. Ann Rheum Dis 71:1278–1288

    Article  PubMed  Google Scholar 

  10. Madsen KB, Jurik AG (2010) Magnetic resonance imaging grading system for active and chronic spondylarthritis changes in the sacroiliac joint. Arthritis Care Res (Hoboken) 62:11–18

    Article  Google Scholar 

  11. Rudwaleit M, Jurik AG, Hermann KG et al (2009) Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis 68:1520–1527

    Article  CAS  PubMed  Google Scholar 

  12. Arnbak B, Jensen TS, Manniche C, Zejden A, Egund N, Jurik AG (2013) Spondyloarthritis-related and degenerative MRI changes in the axial skeleton - an inter- and intra-observer agreement study. BMC Musculoskelet Disord 14:274

    Article  PubMed  PubMed Central  Google Scholar 

  13. Manniche C, Asmussen K, Lauritsen B, Vinterberg H, Kreiner S, Jordan A (1994) Low Back Pain Rating scale: validation of a tool for assessment of low back pain. Pain 57:317–326

    Article  CAS  PubMed  Google Scholar 

  14. Kent P, Lauridsen HH (2011) Managing missing scores on the Roland Morris Disability Questionnaire. Spine (Phila Pa 1976) 36:1878–1884

    Article  Google Scholar 

  15. Roland M, Morris R (1983) A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976) 8:141–144

    Article  CAS  Google Scholar 

  16. EuroQol G (1990) EuroQol: a new facility for the measurement of health-related quality of life. Health Policy 16:199–208

    Article  Google Scholar 

  17. Teraguchi M, Yoshimura N, Hashizume H et al (2014) Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama Spine Study. Osteoarthr Cartil 22:104–110

    Article  CAS  PubMed  Google Scholar 

  18. Albert HB, Manniche C (2007) Modic changes following lumbar disc herniation. Eur Spine J 16:977–982

    Article  PubMed  PubMed Central  Google Scholar 

  19. Keller A, Boyle E, Skog TA, Cassidy JD, Bautz-Holter E (2012) Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain? Eur Spine J 21:418–424

    Article  PubMed  PubMed Central  Google Scholar 

  20. Saberi H, Rahimi L, Jahani L (2009) A comparative MRI study of upper and lower lumbar motion segments in patients with low back pain. J Spinal Disord Tech 22:507–510

    Article  PubMed  Google Scholar 

  21. Modic MT, Obuchowski NA, Ross JS et al (2005) Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiology 237:597–604

    Article  PubMed  Google Scholar 

  22. McNee P, Shambrook J, Harris EC et al (2011) Predictors of long-term pain and disability in patients with low back pain investigated by magnetic resonance imaging: a longitudinal study. BMC Musculoskelet Disord 12:234

    Article  PubMed  PubMed Central  Google Scholar 

  23. Carragee EJ, Alamin TF, Miller JL, Carragee JM (2005) Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine J 5:24–35

    Article  PubMed  Google Scholar 

  24. Karppinen J, Malmivaara A, Tervonen O et al (2001) Severity of symptoms and signs in relation to magnetic resonance imaging findings among sciatic patients. Spine (Phila Pa 1976) 26:E149–E154

    Article  CAS  Google Scholar 

  25. Peterson CK, Humphreys BK, Pringle TC (2007) Prevalence of modic degenerative marrow changes in the cervical spine. J Manip Physiol Ther 30:5–10

    Article  Google Scholar 

  26. Mann E, Peterson CK, Hodler J (2011) Degenerative marrow (modic) changes on cervical spine magnetic resonance imaging scans: prevalence, inter- and intra-examiner reliability and link to disc herniation. Spine (Phila Pa 1976) 36:1081–1085

    Article  Google Scholar 

  27. Matsumoto M, Okada E, Ichihara D et al (2010) Prospective ten-year follow-up study comparing patients with whiplash-associated disorders and asymptomatic subjects using magnetic resonance imaging. Spine (Phila Pa 1976) 35:1684–1690

    Article  Google Scholar 

  28. Arana E, Marti-Bonmati L, Molla E, Costa S (2004) Upper thoracic-spine disc degeneration in patients with cervical pain. Skelet Radiol 33:29–33

    Article  Google Scholar 

  29. Albert HB, Kjaer P, Jensen TS, Sorensen JS, Bendix T, Manniche C (2008) Modic changes, possible causes and relation to low back pain. Med Hypotheses 70:361–368

    Article  CAS  PubMed  Google Scholar 

  30. Matsumoto M, Okada E, Toyama Y, Fujiwara H, Momoshima S, Takahata T (2013) Tandem age-related lumbar and cervical intervertebral disc changes in asymptomatic subjects. Eur Spine J 22:708–713

    Article  PubMed  PubMed Central  Google Scholar 

  31. Jensen TS, Bendix T, Sorensen JS, Manniche C, Korsholm L, Kjaer P (2009) Characteristics and natural course of vertebral endplate signal (Modic) changes in the Danish general population. BMC Musculoskelet Disord 10:81

    Article  PubMed  PubMed Central  Google Scholar 

  32. Christensen AI, Ekholm O, Davidsen MKJ (2012) Sundhed og sygelighed i Danmark 2010 & udviklingen siden 1987. National Institute of Public Health, University of Southern Denmark, Copenhagen

    Google Scholar 

  33. Visser LH, Nijssen PG, Tijssen CC, van Middendorp JJ, Schieving J (2013) Sciatica-like symptoms and the sacroiliac joint: clinical features and differential diagnosis. Eur Spine J 22:1657–1664

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Madani SP, Dadian M, Firouznia K, Alalawi S (2013) Sacroiliac joint dysfunction in patients with herniated lumbar disc: a cross-sectional study. J Back Musculoskelet Rehabil 26:273–278

    PubMed  Google Scholar 

  35. Schwarzer AC, Aprill CN, Bogduk N (1995) The sacroiliac joint in chronic low back pain. Spine (Phila Pa 1976) 20:31–37

    Article  CAS  Google Scholar 

  36. Endean A, Palmer KT, Coggon D (2011) Potential of magnetic resonance imaging findings to refine case definition for mechanical low back pain in epidemiological studies: a systematic review. Spine (Phila Pa 1976) 36:160–169

    Article  Google Scholar 

  37. Jensen TS, Karppinen J, Sorensen JS, Niinimaki J, Leboeuf-Yde C (2008) Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J 17:1407–1422

    Article  PubMed  PubMed Central  Google Scholar 

  38. Weber U, Zubler V, Pedersen SJ et al (2013) Development and validation of a magnetic resonance imaging reference criterion for defining a positive sacroiliac joint magnetic resonance imaging finding in spondyloarthritis. Arthritis Care Res (Hoboken) 65:977–985

    Article  CAS  Google Scholar 

  39. Song IH, Hermann K, Haibel H et al (2011) Effects of etanercept versus sulfasalazine in early axial spondyloarthritis on active inflammatory lesions as detected by whole-body MRI (ESTHER): a 48-week randomised controlled trial. Ann Rheum Dis 70:590–596

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. O'Shea FD, Boyle E, Salonen DC et al (2010) Inflammatory and degenerative sacroiliac joint disease in a primary back pain cohort. Arthritis Care Res (Hoboken) 62:447–454

    Article  Google Scholar 

  41. Ubelaker DH, De La Paz JS (2012) Skeletal indicators of pregnancy and parturition: a historical review. J Forensic Sci 57:866–872

    Article  PubMed  Google Scholar 

  42. Wurdinger S, Humbsch K, Reichenbach JR, Peiker G, Seewald HJ, Kaiser WA (2002) MRI of the pelvic ring joints postpartum: normal and pathological findings. J Magn Reson Imaging 15:324–329

    Article  PubMed  Google Scholar 

  43. Hansen A, Jensen DV, Larsen EC et al (2005) Postpartum pelvic pain: the "pelvic joint syndrome": a follow-up study with special reference to diagnostic methods. Acta Obstet Gynecol Scand 84:170–176

    Article  PubMed  Google Scholar 

  44. Weber U, Pedersen SJ, Ostergaard M, Rufibach K, Lambert RG, Maksymowych WP (2012) Can erosions on MRI of the sacroiliac joints be reliably detected in patients with ankylosing spondylitis? - A cross-sectional study. Arthritis Res Ther 14:R124

    Article  PubMed  PubMed Central  Google Scholar 

  45. Geijer M, Gadeholt Gothlin G, Gothlin JH (2009) The validity of the New York radiological grading criteria in diagnosing sacroiliitis by computed tomography. Acta Radiol 50:664–673

    Article  CAS  PubMed  Google Scholar 

  46. Lim YZ, Wang Y, Wluka AE et al (2013) Are biomechanical factors, meniscal pathology, and physical activity risk factors for bone marrow lesions at the knee? A systematic review. Semin Arthritis Rheum 43:187–194

    Article  PubMed  Google Scholar 

  47. Sowers MF, Hayes C, Jamadar D et al (2003) Magnetic resonance-detected subchondral bone marrow and cartilage defect characteristics associated with pain and X-ray-defined knee osteoarthritis. Osteoarthr Cartil 11:387–393

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors extend thanks to the patients and staff of the Spine Centre of Southern Denmark who participated in the data collection and Suzanne Capell, academic English language editor, for proofreading. The study was financially supported by the Foundation for Chiropractic Research and Post Graduate Education, The Danish Rheumatism Association and the Region of Southern Denmark.

The scientific guarantor of this publication is Professor Claus Manniche, DMSc. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. No complex statistical methods were necessary for this paper. Institutional Review Board approval was not required because the Regional Scientific Ethics Committee for Southern Denmark) determined that under the Danish legal framework, this study did not require formal ethics approval, reference number S-2010200-58. Written informed consent was waived by the Institutional Review Board; however, each patient gave written informed consent for research use and publication of their data. Some study subjects in the cohort have been previously reported in Arnbak B, Jensen TS, Manniche C, Zejden A, Egund N, Jurik AG (2013) Spondyloarthritis-related and degenerative MRI changes in the axial skeleton - an inter- and intra-observer agreement study. BMC Musculoskelet Disord 14:274. Methodology: prospective, cross-sectional study, performed at one institution.

Author information

Authors and Affiliations

  1. Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Oestre Hougvej 55, Middelfart, 5500, Denmark

    Bodil Arnbak, Tue S. Jensen, Claus Manniche & Anne G. Jurik

  2. Institute of Regional Health Research, University of Southern Denmark, Winsloewparken 19, Odense C, 5000, Denmark

    Bodil Arnbak, Tue S. Jensen, Kim Hørslev-Petersen, Claus Manniche & Anne G. Jurik

  3. Department of Radiology, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark

    Niels Egund, Anna Zejden & Anne G. Jurik

  4. King Christian 10th Hospital for Rheumatic Diseases, Toldbogade 63, 6300, Gråsten, Graasten, Denmark

    Kim Hørslev-Petersen

Authors
  1. Bodil Arnbak
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Corresponding author

Correspondence to Bodil Arnbak.

Appendices

Appendix 1

Table 5 Magnetic resonance imaging (MRI) scan protocol
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Appendix 2

Table 6 Definitions of magnetic resonance imaging (MRI) findings assessed in the spine and sacroiliac joints
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Arnbak, B., Jensen, T.S., Egund, N. et al. Prevalence of degenerative and spondyloarthritis-related magnetic resonance imaging findings in the spine and sacroiliac joints in patients with persistent low back pain. Eur Radiol 26, 1191–1203 (2016). https://doi.org/10.1007/s00330-015-3903-0

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  • DOI: https://doi.org/10.1007/s00330-015-3903-0

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