High-sensitivity C-reactive protein in chronic low back pain with vertebral end-plate Modic signal changes. 2007

François Rannou, and Walid Ouanes, and Isabelle Boutron, and Bianca Lovisi, and Fouad Fayad, and Yann Macé, and Didier Borderie, and Henri Guerini, and Serge Poiraudeau, and Michel Revel
Assistance Publique-Hôpitaux de Paris, Université René Descartes, Groupe Hospitalier Cochin, Paris, France. francois.rannou@cch.aphp.fr

OBJECTIVE To assess high-sensitivity C-reactive protein (hsCRP) level as a measure of low-grade inflammation in relation to Modic vertebral end-plate marrow signal change on magnetic resonance imaging (MRI) in patients with chronic low back pain. METHODS All patients hospitalized for chronic low back pain in our institution were prospectively enrolled in this pilot study. Serum hsCRP concentration was measured by immunoturbidimetric assay. MR images were evaluated independently by a panel of 2 spine specialists and a radiologist. Recording of clinical parameters, MRI evaluation, and hsCRP level of each patient was blinded. RESULTS Three groups of 12 consecutive patients (Modic 0, Modic I, and Modic II signal changes on MRI) were prospectively selected. Serum hsCRP level was significantly different in the 3 groups (P = 0.002) and especially high in the Modic I group (P = 0.002 compared with Modic 0 and II groups): mean +/- SD 1.33 +/- 0.77 mg/liter in the Modic 0 group, 4.64 +/- 3.09 mg/liter in the Modic I group, and 1.75 +/- 1.30 mg/liter in the Modic II group. The only difference in clinical parameters among the 3 groups (P = 0.001) was that the worst painful moment during the previous 24 hours occurred during the late night and morning for all Modic I patients (P = 0.001 compared with Modic 0 and P = 0.002 compared with Modic II). CONCLUSIONS Low-grade inflammation indicated by high serum hsCRP level in patients with chronic low back pain could point to Modic I signal changes. This result could help physicians predict the patients with Modic I signals to more precisely prescribe the correct imaging procedure and local antiinflammatory treatment in such patients.

UI MeSH Term Description Entries
D007249 Inflammation A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. Innate Inflammatory Response,Inflammations,Inflammatory Response, Innate,Innate Inflammatory Responses
D008159 Lumbar Vertebrae VERTEBRAE in the region of the lower BACK below the THORACIC VERTEBRAE and above the SACRAL VERTEBRAE. Vertebrae, Lumbar
D008279 Magnetic Resonance Imaging Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. Chemical Shift Imaging,MR Tomography,MRI Scans,MRI, Functional,Magnetic Resonance Image,Magnetic Resonance Imaging, Functional,Magnetization Transfer Contrast Imaging,NMR Imaging,NMR Tomography,Tomography, NMR,Tomography, Proton Spin,fMRI,Functional Magnetic Resonance Imaging,Imaging, Chemical Shift,Proton Spin Tomography,Spin Echo Imaging,Steady-State Free Precession MRI,Tomography, MR,Zeugmatography,Chemical Shift Imagings,Echo Imaging, Spin,Echo Imagings, Spin,Functional MRI,Functional MRIs,Image, Magnetic Resonance,Imaging, Magnetic Resonance,Imaging, NMR,Imaging, Spin Echo,Imagings, Chemical Shift,Imagings, Spin Echo,MRI Scan,MRIs, Functional,Magnetic Resonance Images,Resonance Image, Magnetic,Scan, MRI,Scans, MRI,Shift Imaging, Chemical,Shift Imagings, Chemical,Spin Echo Imagings,Steady State Free Precession MRI
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009045 Motor Endplate The specialized postsynaptic region of a muscle cell. The motor endplate is immediately across the synaptic cleft from the presynaptic axon terminal. Among its anatomical specializations are junctional folds which harbor a high density of cholinergic receptors. Motor End-Plate,End-Plate, Motor,End-Plates, Motor,Endplate, Motor,Endplates, Motor,Motor End Plate,Motor End-Plates,Motor Endplates
D010865 Pilot Projects Small-scale tests of methods and procedures to be used on a larger scale if the pilot study demonstrates that these methods and procedures can work. Pilot Studies,Pilot Study,Pilot Project,Project, Pilot,Projects, Pilot,Studies, Pilot,Study, Pilot
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D002097 C-Reactive Protein A plasma protein that circulates in increased amounts during inflammation and after tissue damage. C-Reactive Protein measured by more sensitive methods often for coronary heart disease risk assessment is referred to as High Sensitivity C-Reactive Protein (hs-CRP). High Sensitivity C-Reactive Protein,hs-CRP,hsCRP,C Reactive Protein,High Sensitivity C Reactive Protein
D002908 Chronic Disease Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care (Dictionary of Health Services Management, 2d ed). For epidemiological studies chronic disease often includes HEART DISEASES; STROKE; CANCER; and diabetes (DIABETES MELLITUS, TYPE 2). Chronic Condition,Chronic Illness,Chronically Ill,Chronic Conditions,Chronic Diseases,Chronic Illnesses,Condition, Chronic,Disease, Chronic,Illness, Chronic

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