Oral Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

7 Years Follow-up in a Large Population-Based Cohort: Relationship Between Changes in Low Back Pain and Spinal Phenotypes in the Wakayama Spine Study (115239)

Kimihide Murakami 1 , Masatoshi Teraguchi 1 , Hiroshi Hashizume 1 , Marinko Rade 2 , Jeremy Fairbank 3 , Yuyu Ishimoto 1 , Keiji Nagata 1 , Noriko Yoshimura 4 , Munehito Yoshida 5 , Hiroshi Yamada 1
  1. Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
  2. Orthopedic and Rehabilitation Hospital Martin Horvat, Rovinj, Croatia
  3. Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences,University of Oxford, Oxford
  4. Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo
  5. Department of Orthopaedic Surgery, Sumiya Orthopaedic Hospital, Wakayama

Introduction: Low back pain (LBP) is a globally prevalent musculoskeletal condition that poses significant public health challenges due to its impact on quality of life and socioeconomic burden. While magnetic resonance imaging (MRI) findings such as disc degeneration (DD), Modic changes (MC), and Schmorl's nodes (SN) have been suggested as potential contributors to LBP, their longitudinal relationship remains unclear.

The purpose of this study was to examine the seven-year changes in LBP status and their association with MRI findings (DD, MC, and SN) in a large population-based cohort.

Methods: The Wakayama Spine Study followed 520 participants (mean age 60.3 years, 63.7% follow-up rate) over seven years, starting from 2009. LBP was defined as pain lasting for one month or longer. MRI phenotyping was performed by assessment of DD (using Pfirrmann's system) between L1/2 and L5/S1, MC (identified by diffuse high-intensity signal changes on endplates), and SN (defined as herniation pits with hypointense signals). Multivariate logistic regression analysis examined the relationship between newly developed LBP (71 participants) and baseline DD, MC, and SN, compared to 241 participants without LBP changes, adjusting for sex and age.

Results: After seven years, 46.3% of participants remained pain-free, 13.7% developed new LBP, 25.0% had persistent LBP, and 15.0% had resolved LBP. The prevalence of DD showed minimal increase (89.6% to 92.1%), MC remained stable (47.7% to 46.5%), while SN prevalence notably increased (27.1% to 50.4%). Multivariate analysis revealed no significant associations between newly developed LBP and baseline DD, MC, or SN.

Conclusions: Despite considerable variation in LBP status over seven years, most MRI findings remained relatively stable, except for a marked increase in SN prevalence. The lack of association between baseline MRI findings and new-onset LBP suggests that these structural changes may not be strongly predictive of LBP development in subjects with advanced age. These findings highlight the complex nature of LBP and support the notion that clinical decisions should not be based solely on MRI findings.