Magnetic resonance spectroscopy (MRS) and provocative discography (PD) support improved surgical outcomes for patients with chronic low back pain (CLBP), explained a study published in the 'European Spine Journal'.

The present observational diagnostic development and accuracy study was carried out to improve clinical MRS for better performance. The study also aimed to evaluate if MRS-derived biomarkers are capable of identifying the painful discs,  determining surgical outcomes and quantifying degeneration severity in patients with CLBP.

Total 623 discs in 139 patients were scanned via the MRS and 275 discs also receiving PD.

MRS data was found to be useful in quantifying spectral features related to acidity (lactate, alanine, propionate) and the disc structure (collagen and proteoglycan). The pain potential was calculated using the ratios of acidity to structure. The study authors compared MRS-SCOREs and the Pfirrmann grade and PD.

Clinical efficacy was measured using the surgical success for 75 patients who experienced lumbar surgery. The successful MRS and independent pain diagnosis were observed in Total of 206 discs. MRS revealed about 85% total accuracy, 82% sensitivity, and 88% specificity as compared to the PD. These values increased to 93%, 91%, and 93%, considering the non-herniated discs. Also, a significant difference was observed between the MRS structure and Pfirrmann grades, except grade I versus grade II. The surgical success was 97% for the MRS positive discs when all the MRS positive discs were treated whereas  57%  was observed when the treated level was MRS negative. Surgical success was found to be 54% when the non-treated adjacent level was MRS positive. The study authors found painless MRS to be a useful approach in understanding the pain mechanisms and devising a customized treatment plan for patients with CLBP.