ISSLS PRIZE in Clinical Science 2023: comparison of degenerative MRI features of the intervertebral disc between those with and without chronic low back pain. An exploratory study of two large female populations using automated annotation

A Jamaludin; T Kadir; A Zisserman; I McCall; F M K Williams; H Lang; E Buchanan; J P G Urban; J C T Fairbank

doi:10.1007/s00586-023-07604-9

ISSLS PRIZE in Clinical Science 2023: comparison of degenerative MRI features of the intervertebral disc between those with and without chronic low back pain. An exploratory study of two large female populations using automated annotation

Eur Spine J. 2023 May;32(5):1504-1516. doi: 10.1007/s00586-023-07604-9. Epub 2023 Mar 30.

Authors

A Jamaludin¹, T Kadir², A Zisserman¹, I McCall³, F M K Williams⁴, H Lang⁵, E Buchanan⁶, J P G Urban⁷, J C T Fairbank^{8

9}

Affiliations

¹ Department of Engineering Science, University of Oxford, Oxford, OX1 3PJ, UK.
² Plexalis Ltd, 30 Upper High Street, Thame, OX9 3EZ, UK.
³ Emeritus, Department of Radiology, Robert Jones and Agnes Hunt Hospital, Oswestry, SY10 7AG, UK.
⁴ Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK.
⁵ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK.
⁶ Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, OX3 7HE, UK.
⁷ Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, OX3 7LD, UK.
⁸ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK. jeremy.fairbank@ndorms.ox.ac.uk.
⁹ Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, OX3 7HE, UK. jeremy.fairbank@ndorms.ox.ac.uk.

PMID: 36995419
DOI: 10.1007/s00586-023-07604-9

Abstract

Objectives: The relationship of degeneration to symptoms has been questioned. MRI detects apparently similar disc degeneration and degenerative changes in subjects both with and without back pain. We aimed to overcome these problems by re-annotating MRIs from asymptomatic and symptomatics groups onto the same grading system.

Methods: We analysed disc degeneration in pre-existing large MRI datasets. Their MRIs were all originally annotated on different scales. We re-annotated all MRIs independent of their initial grading system, using a verified, rapid automated MRI annotation system (SpineNet) which reported degeneration on the Pfirrmann (1-5) scale, and other degenerative features (herniation, endplate defects, marrow signs, spinal stenosis) as binary present/absent. We compared prevalence of degenerative features between symptomatics and asymptomatics.

Results: Pfirrmann degeneration grades in relation to age and spinal level were very similar for the two independent groups of symptomatics over all ages and spinal levels. Severe degenerative changes were significantly more prevalent in discs of symptomatics than asymptomatics in the caudal but not the rostral lumbar discs in subjects < 60 years. We found high co-existence of degenerative features in both populations. Degeneration was minimal in around 30% of symptomatics < 50 years.

Conclusions: We confirmed age and disc level are significant in determining imaging differences between asymptomatic and symptomatic populations and should not be ignored. Automated analysis, by rapidly combining and comparing data from existing groups with MRIs and information on LBP, provides a way in which epidemiological and 'big data' analysis could be advanced without the expense of collecting new groups.

Level of evidence i: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Keywords: Age-related degenerative changes; Automated annotation of MRI; Epidemiology; Modic signs; Pfirrmann grading; Spinal stenosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Awards and Prizes*
Cross-Sectional Studies
Female
Humans
Intervertebral Disc Degeneration* / diagnostic imaging
Intervertebral Disc*
Low Back Pain* / diagnostic imaging
Low Back Pain* / epidemiology
Lumbar Vertebrae
Magnetic Resonance Imaging / methods

Grants and funding

WT_/Wellcome Trust/United Kingdom