The presence of bone marrow edema adjacent to vertebral endplates in patients with degenerative lumbar scoliosis may be a cause of low back pain, according to data recently presented.
Kiyotaka Yamada, MD, PhD, said in a presentation the cause of low back pain (LBP) can be controversial in patients with degenerative lumbar scoliosis (DLS), unlike the cause of leg pain, which can often be traced to neural compression, such as stenosis of the spinal canal.
“We suggest that bone marrow edema adjacent to the vertebral endplate of degenerative scoliosis is strongly associated with low back pain,” Yamada said.
Edema grades used
Yamada and colleagues conducted a cross-sectional study of 120 patients older than 65 years of age with DLS. There were 64 patients with LBP and 56 patients without LBP.
The investigators compared the groups according to the duration of LBP, VAS scores for LBP on a 0-mm to 100-mm scale, BMI, radiographic parameters and MRI findings.
Yamada said the clinical differences between the cohorts were not statistically significant.
The study data showed severe LBP in the LBP cohort persisted for long periods of time (37.4 months ± 40.2 months).
For the study, the investigators classified bone marrow edema into three grades where grade 0 was no findings of bone marrow edema, grade 1 was bone marrow edema seen in less than half of the height of the vertebral body and grade 2 was bone marrow edema seen in half of the height of the vertebral body or more.
Yamada told Spine Surgery Today the findings they called bone marrow edema were similar to Modic type 1 changes.
Edema correlated with back pain
According to Yamada, bone marrow edema was significantly more evident in patients with LBP, and edema was present in 96.9%. The control group showed significantly less bone marrow edema, with edema present in 37.5% of those patients. The mean bone marrow edema score was significantly higher in the LBP group (1.5 ± 0.6) than in the control group (0.4 ± 0.6).
“From this result and the study, we suggest that bone marrow edema is correlated with low back pain,” Yamada said.
According to the logistical regression analysis, a patient with grade 2 bone marrow edema had the highest odds ratio of experiencing low back pain (P < .001). In addition, the scores for bone marrow edema and VAS scores correlated in these patients.
Edema on concave side of scoliosis
Yamada said when bone marrow edema was found in a patient in the study, it was located significantly more often on the concave side of the scoliosis.
The investigators noted LBP in patients with DLS may be due to the biomechanical stress and load on the vertebral endplate at the concave side of the scoliosis.
Elderly patients with DLS typically present with a mixture of Modic types 1, 2 and 3 changes due to osteosclerotic changes in the vertebral endplate and fatty bone marrow, according to Yamada.
“In such cases, it is very difficult to evaluate by using Modic changes, so we performed Gd-enhanced MRI to define bone marrow edema,” he told Spine Surgery Today. – by Robert Linnehan
- Yamada K, et al. Paper #17. Presented at: North American Spine Society Annual Meeting; Nov. 12-15, 2014; San Francisco.
- For more information:
- Kiyotaka Yamada, MD, PhD, can be reached at Department of Orthopaedic Surgery, JA Hiroshima General Hospital, 1-3-3, Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan; email: firstname.lastname@example.org.
Disclosure: Yamada reports no relevant financial disclosures.