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actual MRI findings of potentially painful disc?

drusso

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  1. Attending Physician
    Saw this in my email this morning.
    Anyone actually have access to this article in the journal, Spine?

    New MRI tool offers improved method of imaging degeneration
    https://spinalnewsinternational.com/uds-linked-low-back-pain/

    apparently possible to do this on current scanners


    This novel biomarker be must illusory...Axial low back pain in working-aged/non-working adults is a psychiatric disease, a character deficit, or a life foible. This finding will only further medicalize & monetize the misery of people suffering adverse early childhood events, compensation neuroses, and malingering. Instead what is needed is CBT, ACT, and stern lectures about "grit," resiliency, and the virtues of stoicism.

    I want to see a meta-analysis on UTE and back pain.


    The UTE Disc Sign on MRI: A Novel Imaging Biomarker Associated With Degenerative Spine Changes, Low Back Pain and Disability.

    Pang, Henry; Bow, Cora MCMSc, BHS; Cheung, Jason Pui Yin MBBS(HK), MMedSc, FRCS(Edin), FHKCOS, FHKAM(Orth); Zehra, Uruj PhD; Borthakur, Arijitt PhD, MBA; Karppinen, Jaro MD, PhD; Inoue, Nozomu MD, PhD; Wang, Hai-Qiang MD, PhD; Luk, Keith D.K. MCh (Orth), FRCSE, FRCSG, FRACS, FHKAM (Orth); Cheung, Kenneth M.C. MBBS, MD, FRCS, FHKCOS, FHKAM (Orth); Samartzis, Dino DSc, PhD (C), MSc, MA (C), Dip EBHC
    Spine: Post Acceptance: August 1, 2017
    doi: 10.1097/BRS.0000000000002369
    Clinical Case Series: PDF Only
    Abstract
    Study Design. Cross-sectional.

    Objective. To assess the distribution of the ultra-short time-to-echo (UTE) Disc Sign (UDS).and its association with disc degeneration, other MRI phenotypes, pain and disability profiles.

    Summary of Background Data. Disc degeneration has been conventionally assessed by T2-weighted (T2W) signal intensity on MRI; however, its clinical utility has been questionable. UTE MRI assesses short T2 components. The authors have identified a new imaging biomarker on UTE - the UDS.

    Methods. 108 subjects were recruited. T2W MRI assessed disc degeneration and other phenotypes, and T1-rho MRI values represented quantitative proteoglycan disc profiles of L1-S1. UDS was detected on UTE (i.e. hyper-/hypo-intense disc band). A UDS score (cumulative number of UDS levels) and T2W summated lumbar degenerated scores (cumulative disc degeneration score) were assessed. Subject demographics, chronic low back pain (LBP) and disability profiles (Oswestry Disability Index: ODI) were obtained.

    Results. UDS was noted in 39.8% subjects, 61.4% occurred at the lower lumbar spine and 39.5% had multi-level UDS. UDS subjects had significantly greater severity and extent of disc degeneration, and Modic changes (p < 0.05). By disc levels, a higher prevalence of disc degeneration/displacememt, Modic changes and spondylolisthesis were noted in UDS discs than non-UDS discs (p < 0.05). T1-rho values were also lower in UDS discs (p = 0.022). The majority of UDS could not be detected on T2W. The UDS score significantly correlated with worse ODI scores (r = 0.311; p = 0.001), whereas T2W cumulative disc degeneration score did not (r = 0.13; p = 0.19). LBP subjects exhibited more multi-level UDS (p < 0.015) but not on T2W MRI (p = 0.53). The UDS score was significantly related to LBP (p = 0.009), whereas T2W cumulative disc degeneration score was not (p = 0.127).

    Conclusions. This is the first study to report "UDS" in humans. UDS is a novel imaging biomarker that is highly associated with degenerative spine changes, chronic LBP and disability than conventional T2W MRI.

    Level of Evidence: 2

    Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
     
    Nov 4, 2004
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    1. Attending Physician
      just like entitlements, i dont think you can put the discogenic back pain/back pain disability genie back into the bottle.
      No one in my patient population understands what grit is. They understand pictures (better if they pop-up). But if there is a way I can show those patients, especially the young with pristine MRIs, that there isn nothing in the spine that indicates discogenic pain, maybe they will look into alternative treatments.
      Maybe this could be the new D-dimer. If its negative, it rules it out, but if its positive, it doesn't really give you any extra info.

      hope that this could potentially be an alternative to discograms or at least be away to avoid sticking an unnecessary disc.

      FreddyDPT, any thoughts on this?
       
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      lobelsteve

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      1. Attending Physician
        just like entitlements, i dont think you can put the discogenic back pain/back pain disability genie back into the bottle.
        No one in my patient population understands what grit is. They understand pictures (better if they pop-up). But if there is a way I can show those patients, especially the young with pristine MRIs, that there isn nothing in the spine that indicates discogenic pain, maybe they will look into alternative treatments.
        Maybe this could be the new D-dimer. If its negative, it rules it out, but if its positive, it doesn't really give you any extra info.

        hope that this could potentially be an alternative to discograms or at least be away to avoid sticking an unnecessary disc.

        FreddyDPT, any thoughts on this?

        Are any discograms ever necessary? I would never undergo one.
         
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        Ducttape

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        1. Attending Physician
          so, in this case....

          if the UDS is Positive, they get the candy????

          in reading actual study, a couple of points. age was clinically significantly higher in patients with UDS. and 52.7% of patents with chronic back pain had negative UDS.


          so when it present, it could be signficant....
           
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          freddydpt

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          1. Attending Physician
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            just like entitlements, i dont think you can put the discogenic back pain/back pain disability genie back into the bottle.
            No one in my patient population understands what grit is. They understand pictures (better if they pop-up). But if there is a way I can show those patients, especially the young with pristine MRIs, that there isn nothing in the spine that indicates discogenic pain, maybe they will look into alternative treatments.
            Maybe this could be the new D-dimer. If its negative, it rules it out, but if its positive, it doesn't really give you any extra info.

            hope that this could potentially be an alternative to discograms or at least be away to avoid sticking an unnecessary disc.

            FreddyDPT, any thoughts on this?
            Let me read the full article and review images and get back to you. Just saw this now.
             
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