• A Jamaludin, T Kadir, A Zisserman, I McCall, WilliamsF M KFMK0000-0002-2998-2744Department of Twin Research and Genetic Epidemiology, King's College London, London, SE1 7EH, UK., H Lang, E Buchanan, UrbanJ P GJPG0000-0002-5780-6713Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, OX3 7LD, UK., and FairbankJ C TJCT0000-0002-0050-874XNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK. jeremy.fairbank@ndorms.ox.ac.uk.Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trus.
• Department of Engineering Science, University of Oxford, Oxford, OX1 3PJ, UK.
• Eur Spine J. 2023 May 1; 32 (5): 150415161504-1516.

ObjectivesThe 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.MethodsWe 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.ResultsPfirrmann 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.ConclusionsWe 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 IDiagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.© 2023. The Author(s).

19 keywords...

hide…