Lumbar MRI and Back Pain After Failed Conservative Treatment: The RuDDS Study

Abstract

Study Design: Prospective disease-oriented study. Objective: To describe the MRI findings in patients with failed conservative treatment for degenerative lumbar diseases and to identify predictors of back pain intensity in these patients. Methods: We analyzed demographic (sex, age) and clinical scale data as well as the lumbar MRI findings (Pfirrmann disc degeneration, Modic types, endplate defects, disc height and osteophytes) in RuDDS patients. We examined the prevalence of degenerative changes in different age groups and searched for predictors of back pain intensity after the procedure in patients with specific leading syndromes. Results: Patients with failed conservative treatment demonstrate more severe degeneration of the discs and endplates, more Modic changes, and higher Jarosz scores than reported in population-based studies. Individuals with degenerative stenosis have the most severe lumbar spine degeneration compared to patients with other leading syndromes (facet joint pain, lumbar disc herniation, degenerative deformity) (P < 0.004). Lumbar MRI findings had a weak (β < 0.1) though statistically significant effect on back pain intensity before the procedure and clinically significant back pain attenuation after it. Smoking had a greater impact on back pain and its attenuation after the procedure, especially in patients with degenerative stenosis (β = 0.307 and OR = 2.03, respectively). Conclusion: This is the first characterization of MRI findings in patients with failed conservative treatment. Smokers show more prominent back pain attenuation after the procedure than non-smokers; however it is not clear whether this treatment effect is sufficient.The trial registry number is NCT04600544 on clinicaltrials.gov.