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Healthcare service use after lumbar spine MRI in general practice
Abstracts / Osteoarthritis and Cartilage 24 (2016) S8eS62
5% (95% CI 4%e6%) increased risk of back pain over the next 12 years, after adjusting for age, height, education status, physical activity and depression. Higher weight also predicted back pain risk over each 3 year survey interval (p<0.001). The effects of weight on back pain were most significant in those with body mass index 25 kg/m2 and were observed at all levels of physical activity. Inadequate physical activity and depression were independent predictors of back pain over the following 12 years (both p<0.001), after adjusting for above confounders. Conclusions: Back pain is common in community-based young adult women. Higher weight, inadequate levels of physical activity and depression were all independent predictors of back pain over the following decade. Furthermore, the adverse effects of weight on back pain were not mitigated by physical activity. Our findings highlight the role of both higher weight and physical inactivity in back pain among young adult women and suggest potential opportunities for future prevention. 7 HEALTHCARE SERVICE USE AFTER LUMBAR SPINE MRI IN GENERAL PRACTICE E.I. de Schepper y, B.W. Koes y, E.F. Veldhuizen z, E.H. Oei y, S.M. Bierma-Zeinstra y, P.A. Luijsterburg y. y Erasmus MC, Rotterdam, Netherlands; z MRI Ctr., Rotterdam, Netherlands Purpose: The use of MRI as the initial imaging for (chronic) back pain has increased in general practice. An understanding of the patterns of healthcare services used after these lumbar MRI's would provide information about how MRI scans are used in primary care. Identification of possible prognostic factors predicting healthcare use can be important to inform patients and physicians. The objective of the study was to investigate the association between patient characteristics, back pain characteristics and MRI abnormalities (including lumbar degeneration) with subsequent specialist consultation and/or surgery in low back pain patients presenting for lumbar MRI as referred by their general practitioners. Methods: This study was a prospective observational cohort study in general practice, with a 12-month follow-up. Patients (aged 18 years and over) presenting for a lumbar MRI examination as referred by their general practitioner were recruited at the MRI Center. The MRI radiology reports were scored regarding the presence of bulging, disc herniation, nerve root compression, spinal stenosis, spondylolisthesis and serious pathologies (i.e. fracture, malignancy, discitis). The questionnaires filled in at baseline, and at 3 and 12-month follow-up, included potential clinical predictors from history taking and use of healthcare services. Multiple (backward) logistic regression analyses were performed to determine which baseline factors were associated with 1) consultation with a specialist and 2) spine surgery. Results: Of the 683 included patients, 301 (55%) reported consultation with a specialist (orthopedic surgeon, neurologist, neurosurgeon, or rheumatologist) during the first 3 months after the MRI scan. In the final model the variables associated with consultation with a specialist were: spinal stenosis seen on MRI (OR 2.3; CI 1.3e4.2), severity of leg pain (0e10) (OR 1.1; CI 1.0e1.2), disability (0e24) (OR 1.1; CI 1.0e1.1), history of back surgery (OR 2.3; CI 1.3e3.8), and recent consultation with a specialist before baseline (OR 2.1; CI 1.2e3.6). The AUC for the final model was 0.70. In total, 124 patients (18%) underwent spine surgery during the 12month follow-up. In the final model the variables associated with surgery during 12 months follow-up were: nerve root compression (OR 2.8; CI 1.5e5.2), spinal stenosis (OR 3.2; CI 1.7e6.0), age (OR 0.98; CI 0.96e1.0), severity of pain radiating in the leg below the knee (OR 1.9; CI 1.1e3.3), baseline disability score (OR 1.1; CI 1.0e1.1), and history of back surgery (OR 2.1; CI 1.2e3.7). The AUC for the final model was 0.75. Conclusions: At 12-month follow-up, 18% of low back pain patients presenting for lumbar MRI as referred by their general practitioner underwent surgery. Six baseline characteristics were associated with surgery during follow-up; including nerve root compression and spinal stenosis on MRI.
S11
Baseline predictors for consultation with specialist (N ¼ 547)
Spinal stenosis on MRI (yes) Severity of leg pain (NRS) Disability (RDQ) History of back surgery (yes) Consultation specialist in 3 months prior to baseline
Pooled OR (95% CI)
P-value (AUC ¼ 0.70)
2.3 1.1 1.1 2.3 2.1
<0.01 <0.01 <0.01 <0.01 <0.01
(1.3e4.2) (1.0e1.2) (1.0e1.1) (1.3e3.8) (1.2e3.6)
Baseline predictors for surgery during 12-month follow-up (N ¼ 477) Pooled OR (95% CI) Nerve root compression on MRI (yes) Spinal stenosis on MRI (yes) Age Pain radiating in the leg below the knee (yes) Disability (RDQ) History of back surgery (yes)
P-value (AUC ¼ 0.75)
2.8 (1.5e5.2)
<0.01
3.2 (1.7e6.0) 0.98 (0.96e1.0) 1.9 (1.1e3.3)
<0.01 <0.05 <0.01
1.1 (1.0e1.1) 2.1 (1.2e3.7)
<0.01 <0.01
8 GENERATION OF HUMAN NUCLEUS PULPOSUS CELLS FROM STEM CELLS: FIRST STEPS TOWARDS INTERVERTEBRAL DISC REGENERATION. P. Colombier y, J. Clouet y, C. Chariau z, C. Chedeville y, J. Lesoeur y, L. Lescaudron y, L. David z, A. Camus y, J. Guicheux y. y INSERMU791LIOAD, Nantes, France; z INSERM UMS016, CNRS UMS 3556, iPSC core facility, Nantes, France Purpose: The nucleus pulposus (NP) is the central part of the intervertebral disc (IVD) and plays a key role in spine kinematic. At birth, the NP is populated by two cell types: the notochord cells (NTCs) known as the NP progenitors and the nucleopulpocytes (NPCytes) which are responsible for the synthesis of NP-specific extracellular matrix. The early decline of the NTCs followed by the progressive disappearance of the NPCytes initiates an irreversible degenerative cascade in the NP ultimately leading to the loss of IVD biomechanical properties. In this context, repopulating a damaged NP with regenerative cells seems to be a promising approach for long-term regeneration of IVD. Our objectives in this study are (i) to generate notochord precursors from human induced pluripotent stem cells (hiPSC) and (ii) NPCyte-like cells from human adipose stromal cells (hASC). Methods: Both Nodal and Wnt signaling pathways are required for the formation of the notochord in the mouse embryo. Notochord cells arise from progenitors expressing FoxA2/Brachyury. Human iPSC differentiation was thus induced with activin A and CHIR99021 (inhibitor of GSK-3). In parallel, NPCyte-like cells were generated from hASC cultured in the presence of both Transforming Growth Factor-b1 (TGF-b1) and Growth Differentiation Factor 5 (GDF5). Results: Our results showed that 30% of differentiated hiPSC expressed both FoxA2 and Brachyury after 24 hours of treatment by activin A and CHIR99021, whereas activin A alone induced only 10% double positive cells. The differentiation of hASC towards NPCyte lineage is robust and highly reproducible (9 patients). In addition, the transplantation of these engineered NPCyte-like cells in nude mice subcutis demonstrated that they survived, maintained their specialized phenotype and secretory activity in vivo. Finally, we have analyzed the role of TGF-b1 and GDF5 canonical pathways during differentiation. Our results indicated that the acquisition of the NPCyte molecular identity was mainly governed by the Smad2/3 pathway while the acquisition of NPCyte morphology was controlled by the Smad1/5/8 pathway.
5% (95% CI 4%e6%) increased risk of back pain over the next 12 years, after adjusting for age, height, education status, physical activity and depression. Higher weight also predicted back pain risk over each 3 year survey interval (p<0.001). The effects of weight on back pain were most significant in those with body mass index 25 kg/m2 and were observed at all levels of physical activity. Inadequate physical activity and depression were independent predictors of back pain over the following 12 years (both p<0.001), after adjusting for above confounders. Conclusions: Back pain is common in community-based young adult women. Higher weight, inadequate levels of physical activity and depression were all independent predictors of back pain over the following decade. Furthermore, the adverse effects of weight on back pain were not mitigated by physical activity. Our findings highlight the role of both higher weight and physical inactivity in back pain among young adult women and suggest potential opportunities for future prevention. 7 HEALTHCARE SERVICE USE AFTER LUMBAR SPINE MRI IN GENERAL PRACTICE E.I. de Schepper y, B.W. Koes y, E.F. Veldhuizen z, E.H. Oei y, S.M. Bierma-Zeinstra y, P.A. Luijsterburg y. y Erasmus MC, Rotterdam, Netherlands; z MRI Ctr., Rotterdam, Netherlands Purpose: The use of MRI as the initial imaging for (chronic) back pain has increased in general practice. An understanding of the patterns of healthcare services used after these lumbar MRI's would provide information about how MRI scans are used in primary care. Identification of possible prognostic factors predicting healthcare use can be important to inform patients and physicians. The objective of the study was to investigate the association between patient characteristics, back pain characteristics and MRI abnormalities (including lumbar degeneration) with subsequent specialist consultation and/or surgery in low back pain patients presenting for lumbar MRI as referred by their general practitioners. Methods: This study was a prospective observational cohort study in general practice, with a 12-month follow-up. Patients (aged 18 years and over) presenting for a lumbar MRI examination as referred by their general practitioner were recruited at the MRI Center. The MRI radiology reports were scored regarding the presence of bulging, disc herniation, nerve root compression, spinal stenosis, spondylolisthesis and serious pathologies (i.e. fracture, malignancy, discitis). The questionnaires filled in at baseline, and at 3 and 12-month follow-up, included potential clinical predictors from history taking and use of healthcare services. Multiple (backward) logistic regression analyses were performed to determine which baseline factors were associated with 1) consultation with a specialist and 2) spine surgery. Results: Of the 683 included patients, 301 (55%) reported consultation with a specialist (orthopedic surgeon, neurologist, neurosurgeon, or rheumatologist) during the first 3 months after the MRI scan. In the final model the variables associated with consultation with a specialist were: spinal stenosis seen on MRI (OR 2.3; CI 1.3e4.2), severity of leg pain (0e10) (OR 1.1; CI 1.0e1.2), disability (0e24) (OR 1.1; CI 1.0e1.1), history of back surgery (OR 2.3; CI 1.3e3.8), and recent consultation with a specialist before baseline (OR 2.1; CI 1.2e3.6). The AUC for the final model was 0.70. In total, 124 patients (18%) underwent spine surgery during the 12month follow-up. In the final model the variables associated with surgery during 12 months follow-up were: nerve root compression (OR 2.8; CI 1.5e5.2), spinal stenosis (OR 3.2; CI 1.7e6.0), age (OR 0.98; CI 0.96e1.0), severity of pain radiating in the leg below the knee (OR 1.9; CI 1.1e3.3), baseline disability score (OR 1.1; CI 1.0e1.1), and history of back surgery (OR 2.1; CI 1.2e3.7). The AUC for the final model was 0.75. Conclusions: At 12-month follow-up, 18% of low back pain patients presenting for lumbar MRI as referred by their general practitioner underwent surgery. Six baseline characteristics were associated with surgery during follow-up; including nerve root compression and spinal stenosis on MRI.
S11
Baseline predictors for consultation with specialist (N ¼ 547)
Spinal stenosis on MRI (yes) Severity of leg pain (NRS) Disability (RDQ) History of back surgery (yes) Consultation specialist in 3 months prior to baseline
Pooled OR (95% CI)
P-value (AUC ¼ 0.70)
2.3 1.1 1.1 2.3 2.1
<0.01 <0.01 <0.01 <0.01 <0.01
(1.3e4.2) (1.0e1.2) (1.0e1.1) (1.3e3.8) (1.2e3.6)
Baseline predictors for surgery during 12-month follow-up (N ¼ 477) Pooled OR (95% CI) Nerve root compression on MRI (yes) Spinal stenosis on MRI (yes) Age Pain radiating in the leg below the knee (yes) Disability (RDQ) History of back surgery (yes)
P-value (AUC ¼ 0.75)
2.8 (1.5e5.2)
<0.01
3.2 (1.7e6.0) 0.98 (0.96e1.0) 1.9 (1.1e3.3)
<0.01 <0.05 <0.01
1.1 (1.0e1.1) 2.1 (1.2e3.7)
<0.01 <0.01
8 GENERATION OF HUMAN NUCLEUS PULPOSUS CELLS FROM STEM CELLS: FIRST STEPS TOWARDS INTERVERTEBRAL DISC REGENERATION. P. Colombier y, J. Clouet y, C. Chariau z, C. Chedeville y, J. Lesoeur y, L. Lescaudron y, L. David z, A. Camus y, J. Guicheux y. y INSERMU791LIOAD, Nantes, France; z INSERM UMS016, CNRS UMS 3556, iPSC core facility, Nantes, France Purpose: The nucleus pulposus (NP) is the central part of the intervertebral disc (IVD) and plays a key role in spine kinematic. At birth, the NP is populated by two cell types: the notochord cells (NTCs) known as the NP progenitors and the nucleopulpocytes (NPCytes) which are responsible for the synthesis of NP-specific extracellular matrix. The early decline of the NTCs followed by the progressive disappearance of the NPCytes initiates an irreversible degenerative cascade in the NP ultimately leading to the loss of IVD biomechanical properties. In this context, repopulating a damaged NP with regenerative cells seems to be a promising approach for long-term regeneration of IVD. Our objectives in this study are (i) to generate notochord precursors from human induced pluripotent stem cells (hiPSC) and (ii) NPCyte-like cells from human adipose stromal cells (hASC). Methods: Both Nodal and Wnt signaling pathways are required for the formation of the notochord in the mouse embryo. Notochord cells arise from progenitors expressing FoxA2/Brachyury. Human iPSC differentiation was thus induced with activin A and CHIR99021 (inhibitor of GSK-3). In parallel, NPCyte-like cells were generated from hASC cultured in the presence of both Transforming Growth Factor-b1 (TGF-b1) and Growth Differentiation Factor 5 (GDF5). Results: Our results showed that 30% of differentiated hiPSC expressed both FoxA2 and Brachyury after 24 hours of treatment by activin A and CHIR99021, whereas activin A alone induced only 10% double positive cells. The differentiation of hASC towards NPCyte lineage is robust and highly reproducible (9 patients). In addition, the transplantation of these engineered NPCyte-like cells in nude mice subcutis demonstrated that they survived, maintained their specialized phenotype and secretory activity in vivo. Finally, we have analyzed the role of TGF-b1 and GDF5 canonical pathways during differentiation. Our results indicated that the acquisition of the NPCyte molecular identity was mainly governed by the Smad2/3 pathway while the acquisition of NPCyte morphology was controlled by the Smad1/5/8 pathway.