When an incidental MRI finding becomes a clinical issue : Posterior lumbar subcutaneous edema in degenerative, inflammatory, and infectious conditions of the lumbar spine

Relevance of Lumbar Subcutaneous Edema and Local Lordosis

Lumbar subcutaneous edema (LSE) is sometimes found within the deep subcutaneous or perifascial tissue on magnetic resonance imaging (MRI) via short-tau inversion recovery or fat-suppressed T2-weighted imaging. It is more likely to occur in older patients and those with obesity. However, no studies have focused on the association between LSE and local alignment. Therefore, the present study aimed to elucidate such an association. This retrospective study included 111 adult symptomatic patients who underwent lumbar plain MRI in a single institution. Patient demographics and the radiographical characteristics of the LSE and non-LSE groups were analyzed. LSE was detected in 30 (27.0%) patients. The L1-S1 angle was significantly lower in the LSE group (P = 0.033), whereas the sacral slope was not different between the groups (P > 0.05). As previously reported, the patients in the LSE group were older (P < 0.001) and had lower body weight (P = 0.015). This study demonstrates that older age and age-related hypolordosis were associated with a significantly higher frequency of LSE.

Ultrasound-Guided Fascial Hydrodissection with Eperisone: A Retrospective Study on Efficacy and Safety in Lumbodorsal Fasciitis Treatment

BACKGROUND Lumbodorsal fasciitis (LF) is a condition in which muscle and fascial lesions cause low back pain (LBP) and limited mobility. This retrospective study aimed to explore the efficacy and safety of ultrasound-guided fascial hydrodissection combined with eperisone for treating LF. MATERIAL AND METHODS A total of 103 patients with LF were selected and divided into a combined therapy (CT) group (ultrasound-guided fascial hydrodissection and oral drugs of eperisone) and single medication (SM) group (oral drugs of celecoxib and eperisone). Outcomes were evaluated using the visual analog scale (VAS) and Oswestry disability index (ODI) at baseline and at 2 weeks, 1 month, and 3 months after treatment. The adverse reactions and complications of the 2 groups were recorded. RESULTS There were no significant differences in the baseline characteristics of the 2 groups (P>0.05). After treatment, all scores showed a statistically significant improvement at 2 weeks and 1 month (P<0.05). The VAS and ODI scores showed a significant effect by time and group (P<0.001). The results also showed significant group-by-time interactions (P<0.001). Patients in the CT group had lower scores at any follow-up time (P<0.05). At 3 months, the scores slightly increased. There were no adverse reactions or complications in the CT group; however, the SM group had 4 cases of gastrointestinal reactions. CONCLUSIONS Ultrasound-guided fascial hydrodissection combined with eperisone therapy can effectively relieve LBP and improve lumbar function in treating LF. Moreover, this procedure is considered safe.

Posterior Subcutaneous Edema at Lumbar Spine MRI: A Systematic Review

RATIONALE AND OBJECTIVES

Edema in the subcutaneous soft tissue of the lumbar spine is a frequent incidental finding in spinal magnetic resonance imaging, however, its exact explanation is yet to be determined. The aim of this paper is to provide a systematic literature review on posterior lumbar subcutaneous edema (LSE).

MATERIALS AND METHODS

The present systematic literature search was carried out in October 2023 using electronic databases: PubMed, Cochrane library, and Scopus.

RESULTS

The current evidence suggests that lumbar edema is correlated with clinical data such as weight and age, and potentially female sex. Moreover, LSE is related to several specific conditions, including both systemic and spinal disorders, such as heart or kidney disorders, as well as low back pain and degenerative and/or inflammatory diseases.

CONCLUSION

It is important to be aware that there is an association between LSE and a variety systemic and spinal disorders.

MR Imaging Radiomics Analysis Based on Lumbar Soft Tissue to Evaluate Lumbar Fascia Changes in Patients with Low Back Pain

RATIONALE AND OBJECTIVES

Clinicians must precisely pinpoint the etiology of low back pain as the number of people suffering from it increases to provide targeted care. The purpose of this paper was to use MR imaging radiomics based on lumbar soft tissue to analyze changes in the lumbar fascia of patients with low back pain.

MATERIALS AND METHODS

We retrospectively analyzed the lumbar MRI of 197 patients with low back pain. Patients were randomly assigned to either the training (n = 138) or validation (n = 59) cohorts. Multivariate logistic regression analysis was used to create radiomics model and combined nomogram model and their predictive performance were evaluated using receiver operating characteristic curves.

RESULTS

Seven radiomics features based on lumbar soft tissue MRI images were established, which performed well in distinguishing between low back pain patients with fascial changes and normal individuals demonstrated an excellent ability to identify differences, with an Area Under Curve (AUC) of 0.92 (95% CI, 0.88-0.96) in the training cohort and 0.84 (95% CI, 0.73-0.96) in the validation cohort, which performed better than the clinical model significantly only.

CONCLUSION

The nomogram based on clinical features and radiomics features of MR images had a good predictive ability to differentiate fascial alterations in patients with low back pain from normal subjects. It had the potential to be used as a decision support tool to assist clinicians in determining the etiology of patients with lower back pain and managing patients promptly, particularly in the early stage of the fasciitis when significant abnormalities on imaging were difficult to detect.

The origin of lumbar subcutaneous edema: two case reports

Since magnetic resonance imaging (MRI) is widely used to evaluate complaints of low back pain, there have been many reports of lumbar subcutaneous edema (LSE). However, the mechanism underlying its development is unknown. We herein report 2 cases that showed the reduction of LSE. These cases suggest details concerning the mechanism underlying the development of LSE. The first case was an obese 70-year-old woman with a history of chronic back pain due to lumbar canal stenosis. MRI revealed LSE extending from the level of the L2 vertebral body to the sacrum. However, LSE was reduced following weight loss due to a stomach ulcer. This case clearly indicated obesity as the cause of LSE. The second case was a nonobese 31-year-old woman with acute excruciating low back pain due to thoracolumbar fascia strain. LSE was observed at the level of the L3-L4 vertebral body. Two weeks later, her low back pain and LSE were reduced. This case suggests that the origin of LSE was impairment of the thoracolumbar fascia due to strain. We hypothesize that the mechanism underlying the development of LSE may be lymphatic or interstitial fluid pooling due to disturbance of the lumbar fascia.

Non-Specific Low Back Pain, Dietary Salt Intake, and Posterior Lumbar Subcutaneous Edema

Low back pain is the world’s leading disability, but the etiology of the majority of low back pain is non-specific with no known cause. Moreover, overuse of opioids to treat low back pain is a widespread problem. This paper proposes that non-specific low back pain may be associated with excessive intake of dietary salt, potentially mediated by posterior lumbar subcutaneous edema. In addition to pain, symptoms of edema include swelling, tightness, and stiff joints, which are common complaints of people with low back pain, along with restricted lumbar range of motion and impaired mobility. Many global populations consume excess sodium chloride, which can lead to fluid overload in hypervolemia, and cause swelling and temporary weight gain associated with low back pain. Numerous conditions comorbid with low back pain are also potentially mediated by excessive salt intake, including migraine headache, hypertension, cardiovascular disease, venous thromboembolism, liver disease, respiratory disorders, chronic kidney disease, pregnancy complications, and multiple sclerosis. Novel approaches to identify and prevent the cause of non-specific low back pain have potential to reduce disability worldwide by reducing low back pain prevalence. More research is needed to confirm the involvement of dietary salt and posterior lumbar subcutaneous edema in non-specific low back pain.

Posterior lumbar subcutaneous edema as the rare sign of IgA vasculitis (Henoch-Schönlein purpura): A case of a child

Posterior lumbar subcutaneous edema (PLSE) is often found on MRI in adults with obesity or various lumbar conditions. We report a case of a 6-year-old boy with IgA vasculitis (Henoch-Schönlein purpura) along with PSLE observed on CT and MRI. The finding is markedly rare in patients with IgA vasculitis, with only limited cases previously reported in the literature. The edema was symmetrically localized along the erector spine muscle with a smooth margin. These findings differed from the irregularly accumulated edema observed in some adult cases. PLSE should not be overlooked as a nonspecific finding. When symmetrical and circumscribed PLSE is found in children, IgA vasculitis should be added to differential diagnosis in PLSE.