Prevalence of degenerative changes of the spine on magnetic resonance images and radiographs in patients aged 16-45 years with chronic back pain of short duration in the Spondyloarthritis Caught Early (SPACE) cohort

Rheumatology (Oxford). 2016 Jan;55(1):56-65. doi: 10.1093/rheumatology/kev283. Epub 2015 Aug 14.


Objectives: To determine the prevalence of degenerative changes (DCs) in the spine of young patients with back pain without axial spondyloarthritis (no-axSpA), with possible axSpA (poss-axSpA) and with definite axSpA (axSpA), as shown on MRI and radiographs.

Methods: Whole-spine MRI and cervical and lumbar radiography were performed in patients ≥16 years of age with chronic back pain (≥3 months, ≤2 years, onset <45 years) and potential axSpA (Spondyloarthritis Caught Early cohort). Patients were classified as no-axSpA, poss-axSpA [not fulfilling the Assessment of Spondyloarthritis International Society (ASAS) axSpA criteria] or axSpA (fulfilling ASAS axSpA criteria). Images (MRI and X-rays) were evaluated on the presence of DCs by two independent readers, blinded to clinical and laboratory information as well as to the results of the other imaging modality. In cases of disagreement, a third reader served as adjudicator. A Chi-square test was used to analyse differences between patient groups according to various selected cut-off points (1-3) of individual DCs.

Results: Of 274 patients (38% male, mean age: 29 years), 25 (9%) were classified as no-axSpA, 134 (48.9%) as poss-axSpA and 115 (42.0%) as axSpA. Two hundred and forty-five (89%) patients had DCs on MRI [21/25 (84%) no-axSpA, 121/134 (90%) poss-axSpA, 103/115 (90%) axSpA, P = 0.792], range 1-29 (median 5.5), and 121 (44%) patients had DCs on radiographs [13/25 (52%) no-axSpA, 62/134 (46%) poss-axSpA, 48/115 (42%) axSpA, P = 0.261], range 1-11 (median 2). Prevalence of DCs was similar between patient groups. DCs were predominantly found in the lumbar spine.

Conclusion: Prevalence of DCs was high in this cohort of young patients with short-term chronic back pain, in accordance with the literature. Prevalence of DCs in no-axSpA patients, poss-axSpA patients and axSpA patients was found to be similar.

Keywords: MRI; axial spondyloarthritis; degenerative changes; radiograph; short-term chronic back pain; whole spine; young population.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Back Pain / diagnosis
  • Back Pain / epidemiology*
  • Back Pain / etiology
  • Cervical Vertebrae / diagnostic imaging
  • Cervical Vertebrae / pathology
  • Chronic Pain / diagnosis
  • Chronic Pain / epidemiology*
  • Chronic Pain / etiology
  • Early Diagnosis*
  • Female
  • Follow-Up Studies
  • Humans
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / pathology
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Prevalence
  • Radiography
  • Spondylarthritis / complications*
  • Spondylarthritis / diagnosis
  • Time Factors
  • Young Adult