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ASSOCIATION OF VERTEBRAL BONE MARROW EDEMA WITH LOW BACK PAIN IN DEGENERATIVE LUMBAR SCOLIOSIS IN THE ELDERLY: A CROSS‐SECTIONAL OBSERVATIONAL STUDY: O68

Nakamae, Toshio; Fujimoto, Yoshinori; Yamada, Kiyotaka; Suzuki, Osami; Hashimoto, Takashi; Matsuura, Masaki; Morisako, Taiki; Olmarker, Kjell

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Spine Journal Meeting Abstracts: 2015 - Volume 2015 - Issue - p 14
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INTRODUCTION: The underlying pathophysiology of low back pain (LBP) in degenerative lumbar scoliosis (DLS) is unclear. The objective of this study was to examine if bone marrow edema (BME) adjacent to the vertebral endplate on magnetic resonance imaging (MRI) was associated with LBP in elderly DLS patients. METHODS: This study is a cross‐sectional observational study. One hundred and twenty DLS patients over 65 years were enrolled. Of these patients, 64 with LBP were allocated to LBP group, and 56 without LBP to control group. DLS was defined as de novo DLS with a Cobb's angle > 10°, developing after bone maturation without previous history of scoliosis. Lumbar radiography, computed tomography (CT), MRI, and tender point examination in the lumbar spine were performed in all patients. On MRI, coronal gadolinium‐contrasted T1‐ or T2‐weighed fat‐saturated images were used to score the size of BME. The prevalence of BME in LBP group and in control group was compared. The radiographic and MRI findings were evaluated by two spine specialists. The intra‐ and inter‐reader kappa value was 0.80 (p<0.001) and 0.79 (p<0.001). RESULTS: The two groups were similar at baseline data of clinical characteristics. BME was found in 62 of 64 (96.9%) patients with LBP compared with 21 of 56 (37.5%) patients with no LBP (P < 0.001). BME located more frequently on the concave side than on the convex side of scoliosis (P < 0.001). Among patients in LBP group, BME score was associated with LBP severity (r = 0.724; P < 0.001). Lumbar tenderness was found in 52 (81.3%) patients in LBP group compared with 4 (7.1%) patients in control group (P < 0.001). DISCUSSION: BME on MRI was closely associated with the presence and severity of LBP in the elderly DLS patients. In DLS patients, the biomechanical stress loaded on the vertebral endplate at the concave side of scoliosis might be the causes of LBP.

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© 2015 Lippincott Williams & Wilkins, Inc.