Population-based cohort study
Objective. We examined associations between common lumbar degenerative changes observed on MRI and present or future low back pain (LBP).
Summary of Background Data.
The association between lumbar MRI degenerative findings and LBP is unclear. Longitudinal studies are sparse.
Participants (n = 3,369) from a population-based cohort study were imaged at study entry, with LBP status measured at baseline and 6-year follow-up. MRI scans were reported on for the presence of a range of MRI findings. LBP status was measured on a 0–10 scale. Regression models were used to estimate the cross-sectional and longitudinal associations between individual and multiple MRI findings and LBP severity. Separate longitudinal analyses were conducted for participants with and without baseline pain.
MRI findings were present in persons with and without back pain at baseline. Higher proportions were found in older age groups. 76.4% of participants had a least one MRI finding and 8.3% had 5 or more different MRI findings. Cross-sectionally, most MRI findings were slightly more common in those with LBP and pain severity was slightly higher in those with MRI findings (ranging from 0.06 for high intensity zone to 0.83 for spondylolisthesis). In the longitudinal analyses we found most MRI findings were not associated with future LBP-severity regardless of the presence or absence of baseline pain. Compared to zero MRI findings, having multiple MRI findings (≥5) was associated with mildly greater pain-severity at baseline (0.84; 0.50 to 1.17) and greater increase in pain-severity over 6 years in those pain free at baseline (1.21; 0.04 to 2.37), but not in those with baseline pain (-0.30; -0.99 to 0.38).
Our study shows that the MRI degenerative findings we examined, individually or in combination, do not have clinically important associations with LBP, with almost all effects less than one unit on a 0–10 pain scale.
Level of Evidence: 3