Can baseline lumbar multifidus morphometry predict pain and disability in the ensuing two years among people with chronic low back pain?

Yu Lok Wong, Yongping Zheng, Marco Yiu Chung Pang, Dino Samartzis, Jaro Karppinen, Dr Maryse Fortin, Jason Pui Yin Cheung

Research output: Unpublished conference presentation (presented paper, abstract, poster)Conference presentation (not published in journal/proceeding/book)Academic researchpeer-review

Abstract

Introduction. Lumbar multifidus (LM) is a spinal stabilizer that is thought to be related to the development or maintenance of chronic low back pain (CLBP). The presence of LM muscle atrophy and/or fatty infiltration on magnetic resonance images (MRI) may indicate suboptimal LM function in people with CLBP. However, other factors (e.g., Modic changes (MC), facet joint degeneration (FJD), psychological factors, sleep disturbances and multisite pain) may affect symptoms and functioning of patients with CLBP. Therefore, this study aimed to determine whether aberrant baseline LM characteristics on MRI could predict the prognosis of people with CLBP at 2-year follow-up after considering the above-mentioned confounders at baseline, which would have strong clinical implications.

Methods. Seventy-eight people with CLBP completed an 11-point Numeric Pain Rating scale (NPRS), Rolland-Morris Disability Questionnaire (RMDQ), Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), Fear Avoidance Belief Questionnaire (FABQ), and Insomnia Severity Index Scale (ISI). All the participants underwent lumbar MRI in a 1.5 MRI scanner. The total volume of LM, percentage of lean muscle volume of LM, percentage of fatty infiltration in LM over the L3-S1 region were measured manually and then estimated using a customised MATLAB program. MC, disc degeneration, and FJD at the L3-S1 levels were graded by a trained researcher using established grading scales. The association between LM parameters, MC, FJD, psychological factors, sleep disturbances/multisite pain and pain-intensity/disability scores at baseline were analysed by bivariate Spearman’s rank and point-biserial correlation coefficients. Prognostic factors for pain-intensity and disability at the follow-up were then identified using respective multiple regression models at 2-year follow-up among 37 people with CLBP.

Results. Baseline NPRS scores were significantly associated with PCS-Total (ρ=0.29), PCS-Helplessness (ρ=0.34), FABQ-Total (ρ=0.30), FABQ-Work (ρ=0.39), and ISI scores (ρ=0.44) in people with CLBP (P<0.05). Similarly, baseline RMDQ scores were significantly related to HADS-total (ρ=0.26), HADS-Depression (ρ=0.28), PCS-total (ρ=0.29), FABQ-Total (ρ=0.34), FABQ-Physical activity (ρ=0.24), FABQ-Work (ρ=0.24), PCS-Helplessness (ρ=0.33) and ISI scores (ρ=0.24) (P<0.05). MC at L4/5 (point-biserial=0.26), FJD at L4/5 (point-biserial=0.30) and FJD at L4-S1 (point-biserial=0.28) were significantly correlated with pain-intensity (P<0.05). No significant association was noted between RMDQ and LM parameters/other phenotypes and between multisite pain and RMDQ/pain intensity at baseline. Interestingly, only the baseline FABQ-Work score significantly predicted pain-intensity at the 2-year follow-up (accounting for 19% of variance), while baseline PCS-Helplessness and ISI scores significantly predicted disability scores in people with CLBP (accounting together for 12% of variance) at the 2-year follow-up.

Conclusion. Although it was thought that LM parameters were related to clinical outcomes in people with CLBP, our study found that baseline LM characteristics were unrelated to clinical outcomes in this population at baseline or 2-year-follow-up. Conversely, the presence of baseline fear-avoidance beliefs is likely to predict more future LBP pain among people with CLBP. Likewise, higher baseline pain catastrophizing–helplessness scores and ISI scores will increase the risk of more disability among these people in the future. Clinicians should routinely screen for these psychological factors to identify high-risk people with CLBP for timely referral of proper treatments.
Original languageEnglish
Pages79
Number of pages1
Publication statusPublished - 1 May 2023
EventSpineweek 2023 - Melbourne, Melbourne, Australia
Duration: 1 May 20235 May 2023
https://www.spineweek.org/

Competition

CompetitionSpineweek 2023
Country/TerritoryAustralia
CityMelbourne
Period1/05/235/05/23
Internet address

Keywords

  • lumbar multifidus
  • back pain
  • Prospective study
  • Prediction

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