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Magnetic resonance spectroscopy (MRS) identification of chemically painful lumbar discs leads to improved 6-, 12-, and 24-month outcomes for discogenic low back pain surgeries

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Abstract

Purpose

MRS was shown to reliably quantify relative levels of degenerative pain biomarkers, differentiating painful versus non-painful discs in patients with chronic discogenic low back pain (DLBP), and this correlates with surgical success rates. We now report results based on more patients and longer follow-up.

Methods

Disc MRS was performed in DLBP patients who subsequently received lumbar surgery. Custom post-processing (NOCISCAN-LS®; Aclarion Inc.) calculated disc-specific NOCISCORES® that reflect relative differences in degenerative pain biomarkers for diagnosing chemically painful discs. Outcomes in 78 patients were evaluated using Oswestry Disability Index (ODI) scores. Surgical success (≥ 15-point ODI improvement) was compared between surgeries that were “Concordant” (Group C) versus “Discordant” (Group D) with NOCISCORE-based diagnosis for painful discs.

Results

Success rates were higher for Group C versus Group D: 6 months (88% vs. 62%; p = 0.01), 12 months (91% vs. 56%; p < 0.001), and 24 months (85% vs. 63%; p = 0.07). Success rates for Group C surgeries were also higher than Group D surgeries in a variety of sub-group comparisons. Group C had a greater reduction in ODI from pre-operative to follow-up than Group D [absolute change (% change), (p)]: 6 months: − 35 (− 61%) versus − 23 (− 39%), (p < 0.05); 12 months: − 39 (− 69%) versus − 22 (− 39%), (p < 0.01); and 24 months:  − 38 (− 66%) versus − 26 (− 48%), (p < 0.05).

Conclusion

More successful, sustained outcomes were obtained when surgically treating chemically painful discs identified by NOCISCAN-LS post-processed disc MRS exams. Results suggest that NOCISCAN-LS provides a valuable new diagnostic tool to help clinicians better select treatment levels.

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Authors and Affiliations

  1. The Orthopedic Center of St. Louis, 14825 N. Outer Forty Road, Suite 200, St Louis, MO, 63017, USA

    Matthew F. Gornet

  2. Department of Orthopedic Surgery, Scripps Clinic, San Diego, CA, USA

    Robert K. Eastlack

  3. Aclarion, Inc., Broomfield, CO, USA

    James Peacock

  4. SPIRITT Research, St. Louis, MO, USA

    Francine W. Schranck

  5. University of California at San Francisco, San Francisco, CA, USA

    Jeffrey C. Lotz

Authors
  1. Matthew F. Gornet
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  2. Robert K. Eastlack
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  3. James Peacock
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  4. Francine W. Schranck
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  5. Jeffrey C. Lotz
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Corresponding author

Correspondence to Matthew F. Gornet.

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Conflict of interest

The sponsor, Aclarion, Inc., funded the study. No other funds, grants, or other support was received. All authors are stockholders in Aclarion, Inc.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All patients signed an IRB-approved Informed Consent (Western Institutional Review Board).

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Gornet, M.F., Eastlack, R.K., Peacock, J. et al. Magnetic resonance spectroscopy (MRS) identification of chemically painful lumbar discs leads to improved 6-, 12-, and 24-month outcomes for discogenic low back pain surgeries. Eur Spine J 32, 1973–1984 (2023). https://doi.org/10.1007/s00586-023-07665-w

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  • DOI: https://doi.org/10.1007/s00586-023-07665-w

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