Abstract
This retrospective observational study was conducted to identify factors associated with low back-related leg pain (LBLP) using axially loaded magnetic resonance imaging (AL-MRI). Ninety patients with low back pain (LBP) underwent AL-MRI of the lumbar spine. A visual analog scale and patient pain drawings were used to evaluate pain intensity and location and determine LBLP cases. The values of AL-MRI findings were analyzed using a logistic regression model with a binary dependent variable equal to one for low back-related leg pain and zero otherwise. Logistic regression results suggested that intervertebral joint effusion (odds ratio (OR) = 4.58; p = 0.035), atypical ligamenta flava (OR = 5.77; p = 0.003), and edema of the lumbar intervertebral joint (OR = 6.41; p = 0.003) were more likely to be present in LBLP patients. Advanced disc degeneration (p = 0.009) and synovial cysts (p = 0.004) were less frequently observed in LBLP cases. According to the AL-MRI examinations, the odds of having LBLP are more likely if facet effusion, abnormal ligamenta flava, and lumbar facet joint edema are present on imaging than if not. The assessment of lumbar spine morphology in axial loaded MRI adds value to the potential understanding of LBLP, but further longitudinal and loaded–unloaded comparative studies are required to determine the role of acute dynamic changes and instability in LBLP development.
Highlights
Low back-related leg pain (LBLP) refers to neuropathic pain when the lower back nerves are compromised and is often manifested by sciatic or lumbar radicular pain [1].LBLP may not be neuropathic and can manifest as a result of non-neuronal structure involvement in the lumbar spine
The results indicate that the odds of having LBLP are 4.58, 5.77, and 6.41 times more likely if facet effusion, atypical ligamenta flava, and lumbar facet joint edema are present, respectively, on axially loaded magnetic resonance imaging (AL-magnetic resonance imaging (MRI)) imaging than if they are not
The present study evaluated other factors associated with the presence of LBLP in AL-MRI, which have not been previously covered in the literature
Summary
Low back-related leg pain (LBLP) refers to neuropathic pain when the lower back nerves are compromised and is often manifested by sciatic or lumbar radicular pain [1].LBLP may not be neuropathic and can manifest as a result of non-neuronal structure involvement (e.g., the muscles, ligaments, and disc) in the lumbar spine. Low back-related leg pain (LBLP) refers to neuropathic pain when the lower back nerves are compromised and is often manifested by sciatic or lumbar radicular pain [1]. Identifying clinically relevant LBLP subgroups is a priority for low back pain (LBP) research. A distinction between different types of LBP is necessary for clinical treatment and research applications, but there is no clear consensus on the definition and identification of LBLP owing to nerve root involvement [2,3]. The LBLP subgroup is frequently considered neuropathic when neural tissue in the low back is compromised (e.g., nerve root, dorsal root ganglion), commonly referred to as sciatic or lumbar radicular pain [3,4]
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