Prospective Comparison of Changes in Lumbar Spine MRI Findings over Time between Individuals with Acute Low Back Pain and Controls: An Exploratory Study

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Fig 1.
Bar chart showing proportions of subjects and controls for whom a definite or probable change occurred in MR imaging findings with time. DD indicates disc degeneration; SI, signal intensity; DH, disc herniation; MC, Modic changes; Spondy/Retro, spondylolisthesis or retrolisthesis.
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Fig 2.
Images of an annular fissure from 1 participant with LBP showing an example of definite change.
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Fig 3.
Images of disc herniation from 1 participant with LBP showing evidence of definite change.
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Fig 4.
Images of a high-intensity zone from 1 participant with LBP showing evidence of probable change.

Table 1:

MRI findings and the method of assessment at each spinal level

MRI Finding	Method of Scoring at Each Spinal Level
Disc degeneration	Scale of Pfirrmann et al; 1–5¹³
Signal intensity loss	Hypointense, intermediate, hyperintense¹³
Disc height loss	Absent, mild, moderate, severe¹³
Modic changes	According to Fardon et al¹⁴ combined task force; present or absent
Annular fissure	According to Fardon et al¹⁴ combined task force; present or absent
HIZ	According to April and Bogduk¹¹ and Fardon et al¹⁴ combined task force; present or absent
Disc herniation	According to Fardon et al¹⁴ combined task force; normal, protrusion, extrusion, sequestration
Canal stenosis	None, mild, moderate, severe¹²
Spondylolisthesis or retrolisthesis	Present or absent¹²
Edema (posterior elements)	Present or absent
Nerve root compression	No contact, contact, contact and deviation, compression¹⁵
Facet joint arthropathy	None, mild, moderate, severe¹²

Table 2:

Baseline characteristics and MRI findings of participants

Variable	LBP Participants (n = 20)	Control Participants (n = 10)
Female sex (No.) (%)	9 (45%)	5 (50%)
Age (mean) (SD) (yr)	37.4 (9.4)	39.8 (9.4)
≥2 previous episodes (%)	55%	50%
Pain intensity (mean) (SD) (NPRS)	5.95 (1.47)	0
Duration of current episode (median) (IQR) (day)	6.5 (3.3–9.5)	0
Disc degeneration ≥3 (No.) (%)	16 (80%)	6 (60%)
Signal intensity loss (No.) (%)	12 (60%)	4 (40%)
Disc height loss (No.) (%)	2 (10%)	2 (20%)
Modic changes (No.) (%)	6 (30%)	2 (20%)
Annular fissure (No.) (%)	3 (15%)	1 (10%)
HIZ (No.) (%)	10 (50%)	6 (60%)
Disc herniation total (No.) (%)	20 (100%)	9 (90%)
Canal stenosis (No.) (%)	2 (10%)	0 (0%)
Spondylolisthesis or retrolisthesis (No.) (%)	6 (30%)	4 (40%)
Facet joint arthropathy (No.) (%)	11 (55%)	4 (40%)
Bone edema (posterior elements) (No.) (%)	0 (0%)	1 (10%)
Nerve root compression (No.) (%)	10 (50%)	2 (20%)

Table 3:

Proportion of participants in whom MRI findings worsened or improved during a 12-week period^{^a}

MRI Findings/Subjective Change	Controls			Subjects with LBP
MRI Findings/Subjective Change	Worsened	Improved	Worsened or Improved	Worsened	Improved	Worsened or Improved
Disc degeneration	1/10	0/10	1/10	2/20	0/20	2/20
Disc degeneration	= 10%	= 0%	= 10%	= 10%	= 0%	= 10%
Disc signal intensity	1/10	0/10	1/10	2/20	0/20	2/20
Disc signal intensity	= 10%	= 0%	= 10%	= 10%	= 0%	= 10%
Disc height	1/10	0/10	1/10	0/20	0/20	0/20
Disc height	= 10%	= 0%	= 10%	= 0%	= 0%	= 0%
HIZ	0/10	4/10	4/10	5/20	3/20	8/20
HIZ	= 0%	= 40%	= 40%	= 25%	= 15%	= 40%
Annular fissure	0/10	1/10	1/10	2/20	3/20	5/20
Annular fissure	= 0%	= 10%	= 10%	= 10%	= 15%	= 25%
Modic changes	1/10	1/10	2/10	1/20	2/20	3/20
Modic changes	= 10%	= 10%	= 20%	= 5%	= 10%	= 15%
Disc herniation	0/10	3/10	3/10	7/20	6/20	13/20
Disc herniation	= 0%	= 30%	= 30%	= 35%	= 30%	= 65%
Facet joint arthropathy	0/10	0/10	0/10	0/20	0/20	0/20
Facet joint arthropathy	= 0%	= 0%	= 0%	= 0%	= 0%	= 0%
Central canal stenosis	0/10	0/10	0/10	0/20	0/20	0/20
Central canal stenosis	= 0%	= 0%	= 0%	= 0%	= 0%	= 0%
Spondylolisthesis or retrolisthesis	0/10	0/10	0/10	0/20	0/20	0/20
Spondylolisthesis or retrolisthesis	= 0%	= 0%	= 0%	= 0%	= 0%	= 0%
Edema	0/10	1/10	1/10	0/20	0/20	0/20
Edema	= 0%	= 10%	= 10%	= 0%	= 0%	= 0%
Nerve root compromise	0/10	0/10	0/10	2/20	1/20	3/20
Nerve root compromise	= 0%	= 0%	= 0%	= 20%	= 10%	= 15%

↵a If a particular MRI finding both improved and worsened at different follow-up time points (compared with baseline), we reported the change at or closest to the 12-week time point.