Background/Purpose: To compare demographic characteristics, characteristics of pain and functional status according to the presence of inflammatory anterior or posterior arch MRI abnormalities in low back pain (LBP) patients.

Methods: Design: Monocentric cross-sectional study. Patients: Chronic LBP patients with a lumbar spine MRI planned in the Toulouse Hospital Radiology Center were prospectively selected and filled a standardized questionnaire to get clinical data. MRI: STIR and T1 sagittal images from 3 and 1.5 Tesla MRI going up to T8-T9 stages were reviewed by two experienced rheumatologists, blinded from the diagnosis and clinical data. Inflammatory anterior arch abnormalities (IAAA: i.e.: MODIC I or II, inflammatory corner lesions) and inflammatory posterior arch abnormalities (IPAA: i.e.: pedicle edema, transverse and spinous process edema, interspinous process edema, costo-transverse or zygapophyseal joint arthritis) were collected. Analyses: Clinical data (age, sex, disease duration, ODI, pain VAS, inflammatory pain, NSAIDs efficacy) were compared according to the presence/absence of IAAA or IPAA by Chi2 or Wilcoxon tests.

Results: Ninety-five patients were included in this study, 66 have IPAA. Inter and intra-observer agreement was excellent (κ=0.938). The most prevalent IPAA was zygapophyseal joint arthritis (62.5%), then 31.9% patients have interspinous process edema, 9.7% pedicle edema and 4.2% spinous process edema. Patients with IPAA had more frequently Modic I and/or II lesions than patients without IPAA (39.2% versus 9.5%, p=0.01). There was no statistically significant association between IPAA presence and clinical data, including pain characteristics. IPAA seemed to be more prevalent in women (62.1% versus 41.4%, p=0.06), in patients with longer pain duration (6 years versus 4.75 years, p=0.22), with morning stiffness more than 30 minutes (42.4% versus 24.1%, p=0.2), and with better NSAID response (65.9% versus 55%, p=0.35). Furthermore, patients with Modic I had a better response to NSAIDs (90% versus 52%, p=0.04). Patients with Modic II seemed to be older than patients without Modic (66 years versus 43 years, p=0.0004). Modic I was often associated with IPAA at the same vertebral stage.

Conclusion: The most prevalent IPAA in patients with LBP was zygapophyseal joint arthritis. Modic I and/or II were more prevalent when patients have IPAA. There was no significant association between IPPA presence and clinical data. However, NSAIDs had a better efficacy in patients with Modic I, and Modic I was often associated with IPPA at the same vertebral stage.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/relationship-between-inflammatory-anterior-or-posterior-arch-mri-abnormalities-and-clinical-data-in-low-back-pain-patients/