ISSLS PRIZE in Clinical Science 2023: comparison of degenerative MRI features of the intervertebral disc between those with and without chronic low back pain. An exploratory study of two large female populations using automated annotation

• Published in: European spine journal Vol. 32; no. 5; pp. 1504 - 1516
• Main Authors: Jamaludin, A., Kadir, T., Zisserman, A., McCall, I., Williams, F. M. K., Lang, H., Buchanan, E., Urban, J. P. G., Fairbank, J. C. T.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2023; Springer Nature B.V
• Subjects: Asymptomatic; Automation; Awards and Prizes; Back pain; Cross-Sectional Studies; Degeneration; Degenerative disc disease; Epidemiology; Female; Humans; Intervertebral Disc; Intervertebral Disc Degeneration - diagnostic imaging; Intervertebral discs; Low back pain; Low Back Pain - diagnostic imaging; Low Back Pain - epidemiology; Lumbar Vertebrae; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Medicine; Medicine & Public Health; Neurosurgery; Original Article; Spinal stenosis; Surgical Orthopedics; Modic signs; Automated annotation of MRI; Epidemiology; Pfirrmann grading; Spinal stenosis; Age-related degenerative changes
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-023-07604-9

Objectives The 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. Methods We 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. Results Pfirrmann 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. Conclusions We 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 I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.