Issue: July 2013
July 01, 2013
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Underlying spine pathology seen on imaging influences nonop LBP care

Issue: July 2013
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SCOTTSDALE — Combined data from a randomized controlled trial and a prospective cohort study presented here highlighted the role of underlying spine pathology in the clinical outcomes of guideline-based care for patients with acute low back pain.

“The presence and type of underlying spine pathology does affect the outcome of nonoperative clinical guideline-based treatment for acute lower back pain,” Brian Arthur, DC, MSc, of the International Collaboration on Repair Discoveries and the University of British Columbia in Vancouver, Canada, said at the International Society for the Study of the Lumbar Spine Meeting. “Patients with no identifiable pathology improve the most, while patients with underlying disc degeneration improve the least. In the future, outcome studies of acute lower back pain should control for the presence of diagnostic imaging-identified underlying spine pathology.”

The researchers, who also included Paul Bishop, DC, MD, PhD, and principal investigator Jeffrey Quon, DC, MHSc, PhD, FCCSC, studied 97 adult patients with Quebec Task Force grade I or II acute low back pain without radiculopathy and pain lasting less than 4 weeks. None of the patients enrolled in the study had “red flag” conditions, such as nerve deficits, and none had worker’s compensation or motor vehicle insurance claims, Arthur said. Using plain film radiographs, CTs, MRIs and bone scans, medial branch blocks (MBB), the investigators categorized the patients as having spinal stenosis, facet arthropathy, Thompson grade 3 or higher disc degeneration, or no underlying, identifiable pathology.

The primary outcome measure was a change in Roland-Morris score from baseline to 24 weeks. Secondary measures included changes in physical function and bodily pain.

Brian Arthur

Brian Arthur

Arthur and colleagues found no significant differences between the groups for baseline demographics, or the Roland-Morris, bodily pain or physical function scores.

“Regarding Roland-Morris scores, significant differences between groups were observed at all time points and especially at 24 weeks,” Arthur said. “Patients with the least pathology or no pathology improved the most, whereas those with disc degeneration and multiple pathologies improved the least.”

The study also revealed significant differences for physical function at 24 weeks between the ‘no pathology’ and disc degeneration groups.

“Regarding general bodily pain, there were significant differences observed at all time points — 8 [weeks], 16 [weeks] and 24 weeks,” Arthur said.

“The surgical approach to treating spine disorders is based upon treating specific pathology, while the nonoperative treatment approach is, with a few notable exceptions (e.g., image-guided spine interventions), most commonly generic and makes little or no attempt to consider a tissue specific diagnosis (e.g., advanced disc degeneration or facet arthropathy),” Arthur told Orthopedics Today. “The clinical significance of this study is that it demonstrates that underlying spine pathology is a significant predictor of the clinical outcome of the current gold standard of nonoperative treatment for patient with acute lower back pain.” – by Gina Brockenbrough, MA

Reference:
Arthur B. Paper #2. Presented at: The International Society for the Study of the Lumbar Spine Meeting. May 13-17, 2013; Scottsdale, Ariz.
For more information:
Brian Arthur, DC, MSc, and Jeffrey Quon, DC, MHSc, PhD, FCCSC, are with International Collaboration on Repair Discoveries (ICORD), University of British Columbia (UBC), Vancouver, Canada; the Combined Neurosurgical and Orthopaedic Spine Program, Division of Spine, Department of Orthopaedics, UBC. Quon is also with the School of Population & Public Health, Faculty of Medicine, UBC. Both can be reached at International Collaboration on Repair Discoveries, #6110 – 818 West 10th Avenue, Vancouver, British Columbia, V5Z 19; emails: brian.arthur@telus.net and quon@mail.ubc.ca.
Disclosures: Quon, Arthur and Bishop have no relevant financial disclosures.