Purpose and background:. MRI findings associated with spondyloarthritis (SpA) can be difficult to distinguish from the more prevalent findings of degeneration. Despite this, the two groups of MRI-findings are often evaluated in separate studies and in different study populations, which may reduce their applicability in daily clinical practice. The purpose of this study was to estimate the prevalence of degenerative and SpA related MRI-findings in the spine and sacroiliac joints (SIJ) in patients with persistent LBP. Methods:. Patients with persistent LBP (n=1037, median age 33 [IQR 27–37], 54% women) referred to an outpatient, secondary care and non-surgical department were included in the study. MRI of the whole spine and the SIJ was performed and degenerative and SpA-related MRI-findings were evaluated by experienced musculoskeletal radiologists. Results:. The prevalence of disc degeneration, disc contour changes, and Modic changes were 87%(±1.1), 82%(±1.2) and 48%(±1.6). All degenerative spinal findings were most frequent in men and patients aged 30–40 years. Spinal SpA-related MRI-findings were rare. In the SIJ, 28%(±1.4) had at least one MRI finding, with bone marrow oedema (BMO) being the most common (21%(±1.3)). SIJ erosions were most prevalent in patients aged 18–29 years and BMO in patients aged 30–40 years. SIJ sclerosis and fatty marrow deposition were most common in women. Post hoc analysis showed that SIJ BMO, sclerosis and erosions were most frequent in women indicating pregnancy-related LBP. Conclusion:. The high prevalence of SIJ MRI findings associated with age, gender, and pregnancy-related LBP need further investigation of their clinical importance in patients with persistent LBP

Vertebral compression fractures are the most prevalent complication of osteoporosis and percutaneous vertebroplasty (PVP) has emerged as a promising addition to the methods of treating the debilitating pain they may cause.

Since PVP was first reported in the literature in 1987, more than 600 clinical papers have been published on the subject. Most report excellent improvements in pain relief and quality of life. However, these papers have been based mostly on uncontrolled cohort studies with a wide variety of inclusion and exclusion criteria. In 2009, two high-profile randomised controlled trials were published in the New England Journal of Medicine which led care providers throughout the world to question the value of PVP. After more than two decades a number of important questions about the mechanism and the effectiveness of this procedure remain unanswered.

The optimal timing of percutaneous vertebroplasty as treatment for painful osteoporotic vertebral compression fractures (OVCFs) is still unclear. With the position of vertebroplasty having been challenged by recent placebo-controlled studies, appropriate timing gains importance.

We investigated the relationship between the onset of symptoms – the time from fracture – and the efficacy of vertebroplasty in 115 patients with 216 painful subacute or chronic OVCFs (mean time from fracture 6.0 months (sd 2.9)). These patients were followed prospectively in the first post-operative year to assess the level of back pain and by means of health-related quality of life (HRQoL). We also investigated whether greater time from fracture resulted in a higher risk of complications or worse pre-operative condition, increased vertebral deformity or the development of nonunion of the fracture as demonstrated by the presence of an intravertebral cleft.

It was found that there was an immediate and sustainable improvement in the level of back pain and HRQoL after vertebroplasty, which was independent of the time from fracture. Greater time from fracture was associated with neither worse pre-operative conditions nor increased vertebral deformity, nor with the presence of an intravertebral cleft.

We conclude that vertebroplasty can be safely undertaken at an appropriate moment between two and 12 months following the onset of symptoms of an OVCF.

Low back injuries account for the greatest loss of playing time for professional fast bowlers in cricket. Previous radiological studies have shown a high prevalence of degeneration of the lumbar discs and stress injuries of the pars interarticularis in elite junior fast bowlers. We have examined MRI appearance of the lumbar spines of 36 asymptomatic professional fast bowlers and 17 active control subjects. The fast bowlers had a relatively high prevalence of multi-level degeneration of the lumbar discs and a unique pattern of stress lesions of the pars interarticularis on the non-dominant side. The systems which have been used to classify the MR appearance of the lumbar discs and pars were found to be reliable. However, the relationship between the radiological findings, pain and dysfunction remains unclear.