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Low back pain in relation to lumbar spine abnormalities as identified by magnetic resonance imaging

Per Kjær  


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Accepted by: The Faculty of Health Sciences University of Southern Denmark
Defended on: January 13, 2005
Official opponents: Lektor, ph.d. Kirsten Ohm Kyvik , Professor, dr.med. Henrik S. Thomsen , Overlæge, dr.med. Fin Biering-Sørensen
Tutors: Professor, overlæge, dr.med. Tom Bendix , Forskningsprofessor, kiropraktor, MPH, ph.d. Charlotte Leboeuf-Yde , Konstitueret vejleder i efteråret 2003: Professor, overlæge, dr.med. Claus Manniche

Published in the PhD Database: October 11, 2005


English abstract
This Ph.D. thesis is based upon the study ¿The Backs of Funen ¿ what is the source of their pain?¿ The basis of this thesis is the lack of knowledge regarding the clinical relevance of MRI findings in relation to low back pain. The aim of the study was to clarify the incidence of MRI findings and their associations to low back pain in 13- and 40-year old individuals from the general population.
The study involved 412 40-year olds and 439 13-year old children from Funen. All participants underwent an MR scan. Low back pain was determined with questionnaires/interviews.
Low back pain ¿in the last month¿ was reported by 42% of the adults and 22 % of the children, ¿pain during the previous year¿ by 69% of the adults and 41% of the children. Twenty eight percent of the adults and 8% of the children had sought care for their symptoms.
Considerable degenerative discal changes were seen in approximately 50% of the adults and 20% of the children. Disc herniations were found in 25% and 3% of children and adults, while endplate changes were seen in 30% of the adults and 6% of the children. Modic type changes were found in 22% of the adults and spondylolisthesis in 3% in both age groups.
In adults, the MRI findings with the strongest associations to low back pain were Modic changes, spondylolisthesis, and severe fat infiltration in the deep spinal muscles. Degenerative discal changes were moderately associated with LBP. As regards the children, degenerative findings in the discs and endplate irregularities were most strongly associated with low back pain. Disc herniations and spondylolisthesis were strongly associated with seeking care.
Based upon the findings of our study, the greatest clinical relevance of MRI findings in relation to low back pain in adults appears to be Modic type changes. Endplate changes, degeneration of the intervertebral discs and disc herniations are relevant in children, whereas spondylolisthesis is a relevant finding in both children and adults. Definitive conclusions regarding the clinical relevance of MRI findings will require follow-up studies.




Danish abstract
Denne ph.d.-afhandling er baseret på undersøgelsen ¿Fynske Rygge - hvad har de ondt af?¿ Baggrunden er utilstrækkelig viden om klinisk relevans af MR-fund i forhold til lænderygbesvær. Formålet med studiet var at belyse forekomsten af forskellige MR-fund og disses associationer med lænderygbesvær hos 13- og 40-årige fra den generelle befolkning.
I studiet indgik 412 40-årige og 439 13-årige, alle fra Fyn. De fik foretaget MR-skanning og lænderygbesvær blev defineret ud fra spørgeskemaer/interview.
Lænderygbesvær i den seneste måned blev rapporteret af 42 % voksne og 22 % børn. Inden for det sidste år var tallene hhv. 69 % og 41 %. Blandt voksne havde 28 % søgt hjælp for lænderygbesvær; blandt børnene 8%.
Betydelige degenerative discus-forandringer sås hos ca. 50 % af de voksne og 20 % af børnene; discusprolaps hos 25 % af de voksne og hos 3 % af børnene. Endepladeforandringer var til stede hos 30 % voksne og 6 % børn. Modic forandringer sås hos 22 % af de voksne. Tre procent havde spondylolistese i begge aldersgrupper.
MR-fund stærkest associeret med lænderygbesvær var hos voksne spondylolistese, Modic forandringer samt svære fedtinfiltrationer i de dybe rygmuskler. Degenerative discusforandringer var moderat associeret med lænderygbesvær. Hos børn sås de stærkeste associationer for degenerative forandringer i discus og endepladeforandringer. Discusprolaps og spondylolistese var stærkt associeret med at søge hjælp.
Klinisk relevante MR-fund i forhold til lænderygbesvær synes på denne baggrund at være Modic forandringer hos voksne, endepladeforandringer, degenerative discus forandringer og prolaps hos børn, og spondylolistese i begge grupper. Yderligere afklaring omkring den kliniske relevans af forskellige MR-fund kræver svar fra igangværende opfølgningsundersøgelser.