Advanced MR Imaging in Patients With Painful, Degenerative Disc Disease: A Pilot Study

University of California San Francisco (UCSF)

Status

Terminated

Conditions

Degenerative Disc Disease

Treatments

Device: Magnetic Resonance Imaging

Study type

Observational

Funder types

Other

NIH

Identifiers

NCT00706459

SpineMRI

Details and patient eligibility

About

In this study, we will use advanced and newly available MR imaging techniques at 3 Tesla (including in situ axial loading and quantitative T1rho, T2, and diffusion measurements) to assess the intervertebral discs and adjacent vertebrae in patients with lumbar back pain scheduled for back surgery (n=20), patients with degenerative disease without classic discogenic back pain (n=10), patients who had discectomies for herniated discs (n=5), and age-matched volunteers without back pain (n=10). In all patients standard imaging procedures will also be performed, including radiographs, standard MRI at 1.5 Tesla and discography. All patients will have specimen of the intervertebral disc harvested at surgery and pathologic analysis and spectroscopy of these specimen will be performed. Post-surgical findings/outcome combined with discography will serve as a standard of reference for the identification of the painful disc(s). The diagnostic performance of the new techniques in assessing the painful disc will be evaluated. We will collect disc specimens from 50 patients undergoing back surgery but did not have pre-surgical MR imaging. These disc specimens will be analyzed in the same manner as the specimens collected from surgical patients who had pre-surgical MRI. This study will serve as a pilot study for a larger project focusing on advanced imaging of the painful intervertebral disc.

We hypothesis that advanced, dedicated MR examinations at 3T can identify painful degenerated discs in patients with chronic lumbar back pain.

Enrollment

53 patients

Sex

All

Ages

25 to 60 years old

Volunteers

Accepts Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria for Patient with classic discogenic back pain:

age range 25-60 years old
Back and/or leg (back>leg) pain
Degenerative disc disease in one or more adjacent vertebral levels between L3-S1
Radiologic confirmation of degenerative disc disease:
Segmental instability (3 mm translation or 5 degree angulation)
Decreased disc height >2 mm
Scarring, thickening of annulus fibrosis
Vacuum phenomenon
No significant foraminal stenosis and nerve root compression
Failed observative treatment for at least 6 months
Oswestry LB disability questionnaire score of at least 20/50 (40%) (interpreted as moderate to severe disability)
Psychosocially and mentally normal
Patients who are scheduled for back surgery

Inclusion criteria for patients with degenerative disc disease without the classic discogenic back pain:

Age range 25-60 years old
Patients with diagnosis of idiopathic scoliosis, spondylolysis, or spondylolisthesis

Inclusion criteria for normal controls:

No symptoms
Age range 25-60 years old

Inclusion Criteria for post-surgical discectomy patients:

Patients who had successful disc surgery for lumbar herniated disc and no further back pain
Patients who had unsuccessful disc surgery for lumbar herniated disc and still with residual back pain

Exclusion Criteria:

prior back surgery (except as mentioned above)
spine fractures
Radiographic confirmation of facet joint disease or degeneration
Radiographic confirmation of sacroiliac joint pathology
Lytic spondylolisthesis of spinal stenosis
Degenerative spondylolisthesis of > grade 1
Metabolic bone disease
Spine infection , osteomyelitis
Rheumatoid arthritis or any other systemic or autoimmune disease
Active malignancy
MRI Contraindications (fragment in eye, aneurysms clips, ear implants, spinal nerve stimulators, pacemaker, claustrophobia, or pregnant women, etc.,)