Poster Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

DIFFERENCES IN DEMOGRAPHIC AND PAIN-RELATED FEATURES BETWEEN NON-SPECIFIC CHRONIC LOW BACK PAIN PATIENTS WITH OR WITHOUT POTENTIAL DISCOGENIC PAIN     (#35)

Elisabetta de Rinaldis 1 2 , Karim Khattab 3 , Noah B. Bonnheim 3 , Conor ONeill 3 , Jeannie F. Bailey 3 , Jeffrey C. Lotz 3
  1. Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
  2. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
  3. Department of Orthopaedic Surgery, University of California, San Francisco, California, USA

INTRODUCTION: The intervertebral disc can be a pain generator in some patients with non-specific chronic low back pain (cLBP). MR Spectroscopy (Nociscan) has been reported as a non-invasive measurement of chemical biomarkers associated with discogenic pain [1]. Within a heterogeneous population of cLBP patients, we compared patient demographics, pain-related features, and frequency of which spinal levels were affected between patients with and without Nociscan positive discs. These findings begin to uncover whether there are population-level differences in non-specific cLBP patients with or without discogenic pain.

METHODS: A cohort of 130 cLBP patients underwent Nociscan evaluation. Nociscores were calculated for the lumbar intervertebral discs derived using MRS data to indicate potentially painful discs. Based on previous research, a Nociscan positive (Noci+) result signifies a painful disc and Nociscan negative (Noci-) results signifies a non-painful disc [1]. We compared age, BMI, sex, pain interference (Promis domain), and physical function (Promis domain), between patients that had a least one Noci+ disc (Positive Group) and those with only Noci- discs (Negative Group). Next, for level specific analyses, we did logistic regression to compare differences in demographics and patient-reported outcome variables between Noci+ and Noci- at each level.

RESULTS: The 130 patients (77F, 53M) have an average age of 53.2±15.2 and average BMI of 27.2 ± 5.0. The percentage of males was 40.5%, and females were 58.8%. We observed a trend for a higher mean age for Positive Group (54.7±14.5) compared to the Negative Group (48.0±16.5) (p=0.05). The t-tests performed on BMI, pain interference, and physical function did not reveal statistically significant differences between groups (Figure 1). For level specific associations, we observed higher BMI was associated with Noci+ discs at L5S1 (p=0.01) and that higher age associated with Noci+ discs at L3L4 (p=0.04). Pain interference, physical function and sex were not associated with Noci Groups at any level.

DISCUSSION: Nociscan presents a valuable diagnostic tool with the potential to predict the likelihood of discogenic pain for each intervertebral disc. In our study, we calculate Nociscores from a heterogeneous population of non-specific cLBP patients to investigate the role of discogenic pain as a contributing factor in its development and uncover population-level differences among individuals with and without Nociscan-positive discs. Our findings did not show significant associations between discogenic pain and both demographic (age, sex, BMI) and patient-reported outcome variables, emphasizing the importance of further investigation to better understand whether patients experiencing discogenic pain could exhibit distinct treatment outcomes.

REFERENCE: [1] Gornet et al.,Eur Spine J; 2023

Figure 1: Boxplots indicating median, IQ1, and IQ3 for age, BMI, physical function and pain interference for individuals with positive (red) and negative (green) Nociscan results. 

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