Journal of Manipulative and Physiological Therapeutics, 2007
Objective: This study investigates whether it is possible to reproduce the lumbar lordosis in the... more Objective: This study investigates whether it is possible to reproduce the lumbar lordosis in the upright position during magnetic resonance imaging (MRI) by positioning the patient supine with straightened lower extremities and investigates intra-and interexaminer reliability of measurements of the lumbar lordosis on radiographs and MRI. Methods: This was an observational study, which included an intra-and interexaminer reliability study. The lumbar lordosis was measured digitally on radiographs taken from 22 patients in an upright standing position, and 22 MRI scans of the same patients lying supine with straightened lower extremities. These measurements were compared statistically. Intraand interexaminer reliability was calculated applying the Bland and Altman method.
Magnetic resonance imaging (MRI) is used to identify spinal pathoanatomy in people with persisten... more Magnetic resonance imaging (MRI) is used to identify spinal pathoanatomy in people with persistent low back pain. However, the clinical relevance of spinal degenerative MRI findings remains uncertain. Although multiple MRI findings are almost always present at the same time, research into the association with clinical outcomes (such as pain) has predominantly focused on individual MRI findings. This study aimed to: (i) investigate how multiple MRI lumbar spine findings cluster together within two different samples of patients with low back pain, (ii) classify these clusters into hypothetical pathways of degeneration based on scientific knowledge of disco-vertebral degeneration, and (iii) compare these clusters and degenerative pathways between samples. We performed a secondary cross-sectional analysis on two dissimilar MRI samples collected in a hospital department: (1) data from the spinal MRI reports of 4,162 low back pain patients and (2) data from an MRI research protocol of 631 low back pain patients. Latent Class Analysis was used in both samples to cluster MRI findings from lumbar motion segments. Using content analysis, each cluster was then categorised into hypothetical pathways of degeneration. Six clusters of MRI findings were identified in each of the two samples. The content of the clusters in the two samples displayed some differences but had the same overall pattern of MRI findings. Although the hypothetical degenerative pathways identified in the two samples were not identical, the overall pattern of increasing degeneration within the pathways was the same. It was expected that different clusters could emerge from different samples, however, when organised into hypothetical pathways of degeneration, the overall pattern of increasing degeneration was similar and biologically plausible. This evidence of reproducibility suggests that Latent Class Analysis may provide a new approach to investigating the relationship between MRI findings and clinically important characteristics such as pain and activity limitation.
European Spine Journal Official Publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cervical Spine Research Society, Sep 12, 2008
The prevalence of ''vertebral endplate signal changes'' (VESC) and its association with low back ... more The prevalence of ''vertebral endplate signal changes'' (VESC) and its association with low back pain (LBP) varies greatly between studies. This wide range in reported prevalence rates and associations with LBP could be explained by differences in the definitions of VESC, LBP, or study sample. The objectives of this systematic critical review were to investigate the current literature in relation to the prevalence of VESC (including Modic changes) and the association with non-specific low back pain (LBP). The MEDLINE, EMBASE, and SveMED databases were searched for the period 1984 to November 2007. Included were the articles that reported the prevalence of VESC in non-LBP, general, working, and clinical populations. Included were also articles that investigated the association between VESC and LBP. Articles on specific LBP conditions were excluded. A checklist including items related to the research questions and overall quality of the articles was used for data collection and quality assessment. The reported prevalence rates were studied in relation to mean age, gender, study sample, year of publication, country of study, and quality score. To estimate the association between VESC and LBP, 2 9 2 tables were created to calculate the exact odds ratio (OR) with 95% confidence intervals. Eighty-two study samples from 77 original articles were identified and included in the analysis. The median of the reported prevalence rates for any type of VESC was 43% in patients with non-specific LBP and/or sciatica and 6% in non-clinical populations. The prevalence was positively associated with age and was negatively associated with the overall quality of the studies. A positive association between VESC and non-specific LBP was found in seven of ten studies from the general, working, and clinical populations with ORs from 2.0 to 19.9. This systematic review shows that VESC is a common MRI-finding in patients with non-specific LBP and is associated with pain. However, it should be noted that VESC may be present in individuals without LBP. Definition of VESC (yes/no) Subtypes (yes/no) MRI evaluation (0-4 points) Number of observers (stated/not stated) At least one radiologist as observer (yes/no) Observer blinded to symptoms (yes/no) Observer blinded to other observers readings (yes/no) Reproducibility (0-2 points) Reproducibility study performed (yes/no) Results of reproducibility study available (yes/no) Total score: 0-17 points Stated or yes = 1 point Not stated or no = 0 points Eur Spine J (
We would like to express our appreciation of the comments to our paper ''Modic changes (MC) and t... more We would like to express our appreciation of the comments to our paper ''Modic changes (MC) and their associations with clinical findings'' [10]. In our paper, we compare several clinical findings in people with Modic Changes and Disc Degeneration, degeneration only and no MRI findings. The main suggestion in the letter is that Modic Type 1 and Type 2 are different in relation to histopathological findings and should therefore be treated as two distinct subgroups in future studies (REF letter). We do agree with this notion. In our analyses we did not find statistically significant differences and, therefore, we did not report Modic Type 1 and 2 separately. However, in relation to the clinical picture (association with low back pain (LBP)), the distinction between different types of MC is challenging. Several factors such as classification of MC, observer variability and the clinical outcomes could influence the reporting of Modic changes and thus affect the results of the studies.
Journal of Manipulative and Physiological Therapeutics, Jan 2, 2007
Objective: The aims of this study were to investigate the possible prognostic value of disk-relat... more Objective: The aims of this study were to investigate the possible prognostic value of disk-related magnetic resonance imaging (MRI) findings in relation to recovery at 14 months in patients with severe sciatica, and whether improvement of disk herniation and/or nerve root compromise is concurrent with recovery. Methods: All patients included in this prospective observational study of patients with sciatica receiving active conservative treatment were scanned at baseline and at 14 months' follow-up. Definite recovery at follow-up was defined as an absence of sciatic leg pain and a Roland Morris disability score of 3 or less. Potential predictors of interest were diskrelated MRI findings in the lumbar spine. Bi-and multivariate logistic regression analyses were used to identify any predictors of recovery. Age, sex, and treatment were included in the analyses as possible confounding/modifying factors.
Magnetic resonance imaging (MRI) is used to identify spinal pathoanatomy in people with persisten... more Magnetic resonance imaging (MRI) is used to identify spinal pathoanatomy in people with persistent low back pain. However, the clinical relevance of spinal degenerative MRI findings remains uncertain. Although multiple MRI findings are almost always present at the same time, research into the association with clinical outcomes (such as pain) has predominantly focused on individual MRI findings. This study aimed to: (i) investigate how multiple MRI lumbar spine findings cluster together within two different samples of patients with low back pain, (ii) classify these clusters into hypothetical pathways of degeneration based on scientific knowledge of disco-vertebral degeneration, and (iii) compare these clusters and degenerative pathways between samples. We performed a secondary cross-sectional analysis on two dissimilar MRI samples collected in a hospital department: (1) data from the spinal MRI reports of 4,162 low back pain patients and (2) data from an MRI research protocol of 631 low back pain patients. Latent Class Analysis was used in both samples to cluster MRI findings from lumbar motion segments. Using content analysis, each cluster was then categorised into hypothetical pathways of degeneration. Six clusters of MRI findings were identified in each of the two samples. The content of the clusters in the two samples displayed some differences but had the same overall pattern of MRI findings. Although the hypothetical degenerative pathways identified in the two samples were not identical, the overall pattern of increasing degeneration within the pathways was the same. It was expected that different clusters could emerge from different samples, however, when organised into hypothetical pathways of degeneration, the overall pattern of increasing degeneration was similar and biologically plausible. This evidence of reproducibility suggests that Latent Class Analysis may provide a new approach to investigating the relationship between MRI findings and clinically important characteristics such as pain and activity limitation.
The Assessment of SpondyloArthritis international Society (ASAS) has previously published criteri... more The Assessment of SpondyloArthritis international Society (ASAS) has previously published criteria for spondyloarthritis (SpA). The objectives in the current study were in a low back pain (LBP) cohort, including an unknown proportion of SpA patients, to: 1) estimate the prevalence of clinical features and MRI findings included in ASAS criteria, and 2) explore the associations between clinical features and MRI findings. Patients aged 18-40 years with persistent LBP referred to an outpatient spine clinic were included. Information on clinical features (incl. HLA-B27 and CRP) and MRI findings of the spine and sacroiliac joints (SIJ) were collected. Of 1020 included patients, 537(53%) had minimum one clinical feature. Three clinical features were common; inflammatory back pain, good response to NSAID and family disposition (15-17% each). MRI sacroiliitis, according to ASAS definition, was present in 217(21%) patients. Of those, 91(42%) had bone marrow oedema (BMO) at the minimum requirement according to ASAS (low BMO score). HLA-B27, peripheral arthritis, good response to NSAID, and preceding infection associated independently with SIJ MRI findings (OR range 1.9-9.0). The remaining eight clinical features did not associate positively with MRI-findings. Importantly, only age associated independently with low BMO score at the SIJ (OR 1.1 per year). In this population, 53% had minimum one clinical feature and 21% had sacroiliitis according to ASAS; furthermore, the associations between the clinical and imaging domains were inconsistent. The results indicate a need for further investigation of the importance of these findings in spondyloarthritis, including investigation of the minimum requirements for defining MRI sacroiliitis. This article is protected by copyright. All rights reserved.
Large-scale clinical registries are increasingly recognized as important resources for quality as... more Large-scale clinical registries are increasingly recognized as important resources for quality assurance and research to inform clinical decision-making and health policy. We established a clinical registry (SpineData) in a conservative care setting where more than 10,000 new cases of spinal pain are assessed each year. This paper describes the SpineData registry, summarizes the characteristics of its clinical population and data, and signals the availability of these data as a resource for collaborative research projects. The SpineData registry is an Internet-based system that captures patient data electronically at the point of clinical contact. The setting is the government-funded Medical Department of the Spine Centre of Southern Denmark, Hospital Lillebaelt, where patients receive a multidisciplinary assessment of their chronic spinal pain. Started in 2011, the database by early 2015 contained information on more than 36,300 baseline episodes of patient care, plus the available 6-month and 12-month follow-up data for these episodes. The baseline questionnaire completion rate has been 93%; 79% of people were presenting with low back pain as their main complaint, 6% with mid-back pain, and 15% with neck pain. Collectively, across the body regions and measurement time points, there are approximately 1,980 patient-related variables in the database across a broad range of biopsychosocial factors. To date, 36 research projects have used data from the SpineData registry, including collaborations with researchers from Denmark, Australia, the United Kingdom, and Brazil. We described the aims, development, structure, and content of the SpineData registry, and what is known about any attrition bias and cluster effects in the data. For epidemiology research, these data can be linked, at an individual patient level, to the Danish population-based registries and the national spinal surgery registry. SpineData also has potential for the conduct of cohort multiple randomized controlled trials. Collaborations with other researchers are welcome.
To estimate the prevalence of degenerative and spondyloarthritis (SpA)-related magnetic resonance... more To estimate the prevalence of degenerative and spondyloarthritis (SpA)-related magnetic resonance imaging (MRI) findings in the spine and sacroiliac joints (SIJs) and analyse their association with gender and age in persistent low back pain (LBP) patients. Degenerative and SpA-related MRI findings in the whole spine and SIJs were evaluated in Spine Centre patients aged 18-40 years with LBP. Among the 1,037 patients, the prevalence of disc degeneration, disc contour changes and vertebral endplate signal (Modic) changes were 87 % (±SEM 1.1), 82 % (±1.2) and 48 % (±1.6). All degenerative spinal findings were most frequent in men and patients aged 30-40 years. Spinal SpA-related MRI findings were rare. In the SIJs, 28 % (±1.4) had at least one MRI finding, with bone marrow oedema being the most common (21 % (±1.3)). SIJ erosions were most prevalent in patients aged 18-29 years and bone marrow oedema in patients aged 30-40 years. SIJ sclerosis and fatty marrow deposition were most common...
There is a shortage of agreement studies relevant for measuring changes over time in lumbar inter... more There is a shortage of agreement studies relevant for measuring changes over time in lumbar intervertebral disc structures. The objectives of this study were: 1) to develop a method for measurement of intervertebral disc height, anterior and posterior disc material and dural sac diameter using MRI, 2) to evaluate intra- and inter-rater agreement and reliability for the measurements included, and 3) to identify factors compromising agreement. Measurements were performed on MRIs from 16 people with and 16 without lumbar disc herniation, purposefully chosen to represent all possible disc contours among participants in a general population study cohort. Using the new method, MRIs were measured twice by one rater and once by a second rater. Agreement on the sagittal start- and end-slice was evaluated using weighted Kappa. Length and volume measurements were conducted on available slices between intervertebral foramens, and cross-sectional areas (CSA) were calculated from length measureme...
Background: Although reproducibility in reading MRI images amongst radiologists and clinicians ha... more Background: Although reproducibility in reading MRI images amongst radiologists and clinicians has been studied previously, no studies have examined the reproducibility of inexperienced clinicians in extracting pathoanatomic information from magnetic resonance imaging (MRI) narrative reports and transforming that information into quantitative data. However, this process is frequently required in research and quality assurance contexts. The purpose of this study was to examine inter-rater reproducibility (agreement and reliability) among an inexperienced group of clinicians in extracting spinal pathoanatomic information from radiologist-generated MRI narrative reports. Methods: Twenty MRI narrative reports were randomly extracted from an institutional database. A group of three physiotherapy students independently reviewed the reports and coded the presence of 14 common pathoanatomic findings using a categorical electronic coding matrix. Decision rules were developed after initial coding in an effort to resolve ambiguities in narrative reports. This process was repeated a further three times using separate samples of 20 MRI reports until no further ambiguities were identified (total n = 80). Reproducibility between trainee clinicians and two highly trained raters was examined in an arbitrary coding round, with agreement measured using percentage agreement and reliability measured using unweighted Kappa (k). Reproducibility was then examined in another group of three trainee clinicians who had not participated in the production of the decision rules, using another sample of 20 MRI reports.
A prospective observational study of patients with sciatica. To describe the 14-month development... more A prospective observational study of patients with sciatica. To describe the 14-month development of disc-related MRI findings in patients with sciatica receiving active conservative treatment. Previous studies of disc changes over time have reported reduction of herniations in 35% to 100% of cases. This wide range may be explained by differences in patient populations and classifications used to describe disc herniations. Data were obtained from patients with radicular pain (n = 181) who were randomly allocated into one of two active conservative treatment regimens lasting 8 weeks. All patients were scanned at baseline and at 14 months of follow-up. Variables of interest in the present study were disc contour and nerve root compromise at the presumed symptomatic disc level. Disc contour was assessed using the recommendations from the Combined Task Forces of NASS, ASSR, and ASNR. In all, 154 patients were included in this study (70 women and 84 men; range, 18-65 years; mean and median age, 45 years). It was possible to identify the symptomatic disc level in 90% of patients. Extrusions or sequestrations were more common in individuals younger than 45 years and in men. Men were also more likely to have nerve root compromise. Only 3% of bulges and 38% of focal protrusions improved, whereas 75% to 100% of broad-based protrusions, extrusions, and sequestrations improved (P < 0.0001). Nerve root compromise improved in 21% to 80% depending on the disc contour. Neither type of treatment nor age had any effect on the development of MRI findings over time. However, nerve root compromise was more likely to improve in men. This classification system could be used to identify the majority of symptomatic disc levels. At 14 months, the MRI outcome was generally good for disc herniations and nerve root compromise. Nerve root compromise had the best MRI prognosis if the disc was extruded at baseline. There were significant differences between men and women in relation to baseline findings as well as in relation to development of MRI findings over time.
A method comparison study. To investigate the effect of body position and axial load of the lumba... more A method comparison study. To investigate the effect of body position and axial load of the lumbar spine on disc height, lumbar lordosis, and dural sac cross-sectional area (DCSA). SUMMARY OF BACKGROUND DATA.: The effects of flexion and extension on spinal canal diameters and DCSA are well documented. However, the effects of axial loading, achieved by upright standing or by a compression device, are still unclear. Patients with lumbar spinal stenosis were examined in 2 separate studies, including 16 and 20 patients, respectively. In section 1, magnetic resonance imaging (MRI) scans were performed during upright standing and supine positions with and without axial load. In section 2, MRI scans were performed exclusively in supine positions, one with flexion of the lumbar spine (psoas-relaxed position), an extended position (legs straight), and an extended position with applied axial loading. Disc height, lumbar lordosis, and DCSA were measured and the different positions were compared. In section 1, the only significant difference between positions was a reduced lumbar lordosis during standing when compared with lying (P = 0.04), most probably a consequence of precautions taken to secure immobility during the vertical scans. This seemingly makes our standing posture less valuable as a standard of reference. In section 2, DCSA was reduced at all 5 lumbar levels after extension, and further reduced at 2 levels after adding compression (P < 0.05). Significant reductions of disc height were found at 3 motion segments and of DCSA at 11 segments after compression, but these changes were never seen in the same motion segment. Horizontal MRI with the patient supine and the legs straightened was comparable to vertical MRI whether axial compression was added or not. Extensionwas the dominant cause rather than compression in reducing DCSA. Axial load was not considered to have a clinically relevant effect on spinal canal diameters.
Journal of Manipulative and Physiological Therapeutics, 2007
Objective: This study investigates whether it is possible to reproduce the lumbar lordosis in the... more Objective: This study investigates whether it is possible to reproduce the lumbar lordosis in the upright position during magnetic resonance imaging (MRI) by positioning the patient supine with straightened lower extremities and investigates intra-and interexaminer reliability of measurements of the lumbar lordosis on radiographs and MRI. Methods: This was an observational study, which included an intra-and interexaminer reliability study. The lumbar lordosis was measured digitally on radiographs taken from 22 patients in an upright standing position, and 22 MRI scans of the same patients lying supine with straightened lower extremities. These measurements were compared statistically. Intraand interexaminer reliability was calculated applying the Bland and Altman method.
Magnetic resonance imaging (MRI) is used to identify spinal pathoanatomy in people with persisten... more Magnetic resonance imaging (MRI) is used to identify spinal pathoanatomy in people with persistent low back pain. However, the clinical relevance of spinal degenerative MRI findings remains uncertain. Although multiple MRI findings are almost always present at the same time, research into the association with clinical outcomes (such as pain) has predominantly focused on individual MRI findings. This study aimed to: (i) investigate how multiple MRI lumbar spine findings cluster together within two different samples of patients with low back pain, (ii) classify these clusters into hypothetical pathways of degeneration based on scientific knowledge of disco-vertebral degeneration, and (iii) compare these clusters and degenerative pathways between samples. We performed a secondary cross-sectional analysis on two dissimilar MRI samples collected in a hospital department: (1) data from the spinal MRI reports of 4,162 low back pain patients and (2) data from an MRI research protocol of 631 low back pain patients. Latent Class Analysis was used in both samples to cluster MRI findings from lumbar motion segments. Using content analysis, each cluster was then categorised into hypothetical pathways of degeneration. Six clusters of MRI findings were identified in each of the two samples. The content of the clusters in the two samples displayed some differences but had the same overall pattern of MRI findings. Although the hypothetical degenerative pathways identified in the two samples were not identical, the overall pattern of increasing degeneration within the pathways was the same. It was expected that different clusters could emerge from different samples, however, when organised into hypothetical pathways of degeneration, the overall pattern of increasing degeneration was similar and biologically plausible. This evidence of reproducibility suggests that Latent Class Analysis may provide a new approach to investigating the relationship between MRI findings and clinically important characteristics such as pain and activity limitation.
European Spine Journal Official Publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cervical Spine Research Society, Sep 12, 2008
The prevalence of ''vertebral endplate signal changes'' (VESC) and its association with low back ... more The prevalence of ''vertebral endplate signal changes'' (VESC) and its association with low back pain (LBP) varies greatly between studies. This wide range in reported prevalence rates and associations with LBP could be explained by differences in the definitions of VESC, LBP, or study sample. The objectives of this systematic critical review were to investigate the current literature in relation to the prevalence of VESC (including Modic changes) and the association with non-specific low back pain (LBP). The MEDLINE, EMBASE, and SveMED databases were searched for the period 1984 to November 2007. Included were the articles that reported the prevalence of VESC in non-LBP, general, working, and clinical populations. Included were also articles that investigated the association between VESC and LBP. Articles on specific LBP conditions were excluded. A checklist including items related to the research questions and overall quality of the articles was used for data collection and quality assessment. The reported prevalence rates were studied in relation to mean age, gender, study sample, year of publication, country of study, and quality score. To estimate the association between VESC and LBP, 2 9 2 tables were created to calculate the exact odds ratio (OR) with 95% confidence intervals. Eighty-two study samples from 77 original articles were identified and included in the analysis. The median of the reported prevalence rates for any type of VESC was 43% in patients with non-specific LBP and/or sciatica and 6% in non-clinical populations. The prevalence was positively associated with age and was negatively associated with the overall quality of the studies. A positive association between VESC and non-specific LBP was found in seven of ten studies from the general, working, and clinical populations with ORs from 2.0 to 19.9. This systematic review shows that VESC is a common MRI-finding in patients with non-specific LBP and is associated with pain. However, it should be noted that VESC may be present in individuals without LBP. Definition of VESC (yes/no) Subtypes (yes/no) MRI evaluation (0-4 points) Number of observers (stated/not stated) At least one radiologist as observer (yes/no) Observer blinded to symptoms (yes/no) Observer blinded to other observers readings (yes/no) Reproducibility (0-2 points) Reproducibility study performed (yes/no) Results of reproducibility study available (yes/no) Total score: 0-17 points Stated or yes = 1 point Not stated or no = 0 points Eur Spine J (
We would like to express our appreciation of the comments to our paper ''Modic changes (MC) and t... more We would like to express our appreciation of the comments to our paper ''Modic changes (MC) and their associations with clinical findings'' [10]. In our paper, we compare several clinical findings in people with Modic Changes and Disc Degeneration, degeneration only and no MRI findings. The main suggestion in the letter is that Modic Type 1 and Type 2 are different in relation to histopathological findings and should therefore be treated as two distinct subgroups in future studies (REF letter). We do agree with this notion. In our analyses we did not find statistically significant differences and, therefore, we did not report Modic Type 1 and 2 separately. However, in relation to the clinical picture (association with low back pain (LBP)), the distinction between different types of MC is challenging. Several factors such as classification of MC, observer variability and the clinical outcomes could influence the reporting of Modic changes and thus affect the results of the studies.
Journal of Manipulative and Physiological Therapeutics, Jan 2, 2007
Objective: The aims of this study were to investigate the possible prognostic value of disk-relat... more Objective: The aims of this study were to investigate the possible prognostic value of disk-related magnetic resonance imaging (MRI) findings in relation to recovery at 14 months in patients with severe sciatica, and whether improvement of disk herniation and/or nerve root compromise is concurrent with recovery. Methods: All patients included in this prospective observational study of patients with sciatica receiving active conservative treatment were scanned at baseline and at 14 months' follow-up. Definite recovery at follow-up was defined as an absence of sciatic leg pain and a Roland Morris disability score of 3 or less. Potential predictors of interest were diskrelated MRI findings in the lumbar spine. Bi-and multivariate logistic regression analyses were used to identify any predictors of recovery. Age, sex, and treatment were included in the analyses as possible confounding/modifying factors.
Magnetic resonance imaging (MRI) is used to identify spinal pathoanatomy in people with persisten... more Magnetic resonance imaging (MRI) is used to identify spinal pathoanatomy in people with persistent low back pain. However, the clinical relevance of spinal degenerative MRI findings remains uncertain. Although multiple MRI findings are almost always present at the same time, research into the association with clinical outcomes (such as pain) has predominantly focused on individual MRI findings. This study aimed to: (i) investigate how multiple MRI lumbar spine findings cluster together within two different samples of patients with low back pain, (ii) classify these clusters into hypothetical pathways of degeneration based on scientific knowledge of disco-vertebral degeneration, and (iii) compare these clusters and degenerative pathways between samples. We performed a secondary cross-sectional analysis on two dissimilar MRI samples collected in a hospital department: (1) data from the spinal MRI reports of 4,162 low back pain patients and (2) data from an MRI research protocol of 631 low back pain patients. Latent Class Analysis was used in both samples to cluster MRI findings from lumbar motion segments. Using content analysis, each cluster was then categorised into hypothetical pathways of degeneration. Six clusters of MRI findings were identified in each of the two samples. The content of the clusters in the two samples displayed some differences but had the same overall pattern of MRI findings. Although the hypothetical degenerative pathways identified in the two samples were not identical, the overall pattern of increasing degeneration within the pathways was the same. It was expected that different clusters could emerge from different samples, however, when organised into hypothetical pathways of degeneration, the overall pattern of increasing degeneration was similar and biologically plausible. This evidence of reproducibility suggests that Latent Class Analysis may provide a new approach to investigating the relationship between MRI findings and clinically important characteristics such as pain and activity limitation.
The Assessment of SpondyloArthritis international Society (ASAS) has previously published criteri... more The Assessment of SpondyloArthritis international Society (ASAS) has previously published criteria for spondyloarthritis (SpA). The objectives in the current study were in a low back pain (LBP) cohort, including an unknown proportion of SpA patients, to: 1) estimate the prevalence of clinical features and MRI findings included in ASAS criteria, and 2) explore the associations between clinical features and MRI findings. Patients aged 18-40 years with persistent LBP referred to an outpatient spine clinic were included. Information on clinical features (incl. HLA-B27 and CRP) and MRI findings of the spine and sacroiliac joints (SIJ) were collected. Of 1020 included patients, 537(53%) had minimum one clinical feature. Three clinical features were common; inflammatory back pain, good response to NSAID and family disposition (15-17% each). MRI sacroiliitis, according to ASAS definition, was present in 217(21%) patients. Of those, 91(42%) had bone marrow oedema (BMO) at the minimum requirement according to ASAS (low BMO score). HLA-B27, peripheral arthritis, good response to NSAID, and preceding infection associated independently with SIJ MRI findings (OR range 1.9-9.0). The remaining eight clinical features did not associate positively with MRI-findings. Importantly, only age associated independently with low BMO score at the SIJ (OR 1.1 per year). In this population, 53% had minimum one clinical feature and 21% had sacroiliitis according to ASAS; furthermore, the associations between the clinical and imaging domains were inconsistent. The results indicate a need for further investigation of the importance of these findings in spondyloarthritis, including investigation of the minimum requirements for defining MRI sacroiliitis. This article is protected by copyright. All rights reserved.
Large-scale clinical registries are increasingly recognized as important resources for quality as... more Large-scale clinical registries are increasingly recognized as important resources for quality assurance and research to inform clinical decision-making and health policy. We established a clinical registry (SpineData) in a conservative care setting where more than 10,000 new cases of spinal pain are assessed each year. This paper describes the SpineData registry, summarizes the characteristics of its clinical population and data, and signals the availability of these data as a resource for collaborative research projects. The SpineData registry is an Internet-based system that captures patient data electronically at the point of clinical contact. The setting is the government-funded Medical Department of the Spine Centre of Southern Denmark, Hospital Lillebaelt, where patients receive a multidisciplinary assessment of their chronic spinal pain. Started in 2011, the database by early 2015 contained information on more than 36,300 baseline episodes of patient care, plus the available 6-month and 12-month follow-up data for these episodes. The baseline questionnaire completion rate has been 93%; 79% of people were presenting with low back pain as their main complaint, 6% with mid-back pain, and 15% with neck pain. Collectively, across the body regions and measurement time points, there are approximately 1,980 patient-related variables in the database across a broad range of biopsychosocial factors. To date, 36 research projects have used data from the SpineData registry, including collaborations with researchers from Denmark, Australia, the United Kingdom, and Brazil. We described the aims, development, structure, and content of the SpineData registry, and what is known about any attrition bias and cluster effects in the data. For epidemiology research, these data can be linked, at an individual patient level, to the Danish population-based registries and the national spinal surgery registry. SpineData also has potential for the conduct of cohort multiple randomized controlled trials. Collaborations with other researchers are welcome.
To estimate the prevalence of degenerative and spondyloarthritis (SpA)-related magnetic resonance... more To estimate the prevalence of degenerative and spondyloarthritis (SpA)-related magnetic resonance imaging (MRI) findings in the spine and sacroiliac joints (SIJs) and analyse their association with gender and age in persistent low back pain (LBP) patients. Degenerative and SpA-related MRI findings in the whole spine and SIJs were evaluated in Spine Centre patients aged 18-40 years with LBP. Among the 1,037 patients, the prevalence of disc degeneration, disc contour changes and vertebral endplate signal (Modic) changes were 87 % (±SEM 1.1), 82 % (±1.2) and 48 % (±1.6). All degenerative spinal findings were most frequent in men and patients aged 30-40 years. Spinal SpA-related MRI findings were rare. In the SIJs, 28 % (±1.4) had at least one MRI finding, with bone marrow oedema being the most common (21 % (±1.3)). SIJ erosions were most prevalent in patients aged 18-29 years and bone marrow oedema in patients aged 30-40 years. SIJ sclerosis and fatty marrow deposition were most common...
There is a shortage of agreement studies relevant for measuring changes over time in lumbar inter... more There is a shortage of agreement studies relevant for measuring changes over time in lumbar intervertebral disc structures. The objectives of this study were: 1) to develop a method for measurement of intervertebral disc height, anterior and posterior disc material and dural sac diameter using MRI, 2) to evaluate intra- and inter-rater agreement and reliability for the measurements included, and 3) to identify factors compromising agreement. Measurements were performed on MRIs from 16 people with and 16 without lumbar disc herniation, purposefully chosen to represent all possible disc contours among participants in a general population study cohort. Using the new method, MRIs were measured twice by one rater and once by a second rater. Agreement on the sagittal start- and end-slice was evaluated using weighted Kappa. Length and volume measurements were conducted on available slices between intervertebral foramens, and cross-sectional areas (CSA) were calculated from length measureme...
Background: Although reproducibility in reading MRI images amongst radiologists and clinicians ha... more Background: Although reproducibility in reading MRI images amongst radiologists and clinicians has been studied previously, no studies have examined the reproducibility of inexperienced clinicians in extracting pathoanatomic information from magnetic resonance imaging (MRI) narrative reports and transforming that information into quantitative data. However, this process is frequently required in research and quality assurance contexts. The purpose of this study was to examine inter-rater reproducibility (agreement and reliability) among an inexperienced group of clinicians in extracting spinal pathoanatomic information from radiologist-generated MRI narrative reports. Methods: Twenty MRI narrative reports were randomly extracted from an institutional database. A group of three physiotherapy students independently reviewed the reports and coded the presence of 14 common pathoanatomic findings using a categorical electronic coding matrix. Decision rules were developed after initial coding in an effort to resolve ambiguities in narrative reports. This process was repeated a further three times using separate samples of 20 MRI reports until no further ambiguities were identified (total n = 80). Reproducibility between trainee clinicians and two highly trained raters was examined in an arbitrary coding round, with agreement measured using percentage agreement and reliability measured using unweighted Kappa (k). Reproducibility was then examined in another group of three trainee clinicians who had not participated in the production of the decision rules, using another sample of 20 MRI reports.
A prospective observational study of patients with sciatica. To describe the 14-month development... more A prospective observational study of patients with sciatica. To describe the 14-month development of disc-related MRI findings in patients with sciatica receiving active conservative treatment. Previous studies of disc changes over time have reported reduction of herniations in 35% to 100% of cases. This wide range may be explained by differences in patient populations and classifications used to describe disc herniations. Data were obtained from patients with radicular pain (n = 181) who were randomly allocated into one of two active conservative treatment regimens lasting 8 weeks. All patients were scanned at baseline and at 14 months of follow-up. Variables of interest in the present study were disc contour and nerve root compromise at the presumed symptomatic disc level. Disc contour was assessed using the recommendations from the Combined Task Forces of NASS, ASSR, and ASNR. In all, 154 patients were included in this study (70 women and 84 men; range, 18-65 years; mean and median age, 45 years). It was possible to identify the symptomatic disc level in 90% of patients. Extrusions or sequestrations were more common in individuals younger than 45 years and in men. Men were also more likely to have nerve root compromise. Only 3% of bulges and 38% of focal protrusions improved, whereas 75% to 100% of broad-based protrusions, extrusions, and sequestrations improved (P < 0.0001). Nerve root compromise improved in 21% to 80% depending on the disc contour. Neither type of treatment nor age had any effect on the development of MRI findings over time. However, nerve root compromise was more likely to improve in men. This classification system could be used to identify the majority of symptomatic disc levels. At 14 months, the MRI outcome was generally good for disc herniations and nerve root compromise. Nerve root compromise had the best MRI prognosis if the disc was extruded at baseline. There were significant differences between men and women in relation to baseline findings as well as in relation to development of MRI findings over time.
A method comparison study. To investigate the effect of body position and axial load of the lumba... more A method comparison study. To investigate the effect of body position and axial load of the lumbar spine on disc height, lumbar lordosis, and dural sac cross-sectional area (DCSA). SUMMARY OF BACKGROUND DATA.: The effects of flexion and extension on spinal canal diameters and DCSA are well documented. However, the effects of axial loading, achieved by upright standing or by a compression device, are still unclear. Patients with lumbar spinal stenosis were examined in 2 separate studies, including 16 and 20 patients, respectively. In section 1, magnetic resonance imaging (MRI) scans were performed during upright standing and supine positions with and without axial load. In section 2, MRI scans were performed exclusively in supine positions, one with flexion of the lumbar spine (psoas-relaxed position), an extended position (legs straight), and an extended position with applied axial loading. Disc height, lumbar lordosis, and DCSA were measured and the different positions were compared. In section 1, the only significant difference between positions was a reduced lumbar lordosis during standing when compared with lying (P = 0.04), most probably a consequence of precautions taken to secure immobility during the vertical scans. This seemingly makes our standing posture less valuable as a standard of reference. In section 2, DCSA was reduced at all 5 lumbar levels after extension, and further reduced at 2 levels after adding compression (P < 0.05). Significant reductions of disc height were found at 3 motion segments and of DCSA at 11 segments after compression, but these changes were never seen in the same motion segment. Horizontal MRI with the patient supine and the legs straightened was comparable to vertical MRI whether axial compression was added or not. Extensionwas the dominant cause rather than compression in reducing DCSA. Axial load was not considered to have a clinically relevant effect on spinal canal diameters.
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