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Researchers receive $2.5M NIH grant to develop diagnostic tool for common cause of low back pain

Up to 25% of Americans experience low back pain each year, according to the National Institutes for Health. It’s the leading cause of disability worldwide and a substantial health problem with broad clinical, social and economic effects.

Headshot of Prof.Ben WalterWalterAn interdisciplinary Ohio State team led by Biomedical Engineering Assistant Professor Ben Walter and Radiology Associate Professor Arun Kolipaka is developing a safe, non-invasive method to diagnose degeneration of the intervertebral disc (IVD), a common underlying cause of low back pain. They received a five-year, $2.5 million National Institutes of Health award to advance their technique, which, when combined with other advanced imaging methods, could enable early diagnosis of injury and disease as well as evaluation of treatment options.

“Low back pain is one of the largest quality of life issues,” Walter said. “There are many different factors that can contribute to the development of back pain and it's historically difficult to try and diagnose. One of our objectives is to develop a tool to aid clinicians in objectively determining if the disc itself is a potential cause of pain.”

Headshot of Prof. Arun Kolipaka Kolipaka

Current lumbar imaging techniques used to assess low back pain, such as MRI, only offer a subjective assessment of spine anatomy.

“The difficulty right now is when radiologist looks at the images, they have only a qualitative analysis, which can differ from person to person,” said Kolipaka, who is also an adjunct professor of biomedical engineering. “There is no proper non-invasive diagnostic tool to quantify the pain and problematic disc based on the quantitative value.”

“That's one of the challenges the clinicians have,” Walter added, “they can't effectively treat the pain until they have an idea of what is driving the pain.”

The team’s proposed solution, pioneered in Kolipaka’s lab, uses magnetic resonance elastography (MRE), a non-invasive imaging technique that combines MRI imaging with low-frequency vibrations to measure the stiffness of tissues. It will also help doctors differentiate the stages of disease, which the researchers said is becoming increasingly important as personalized treatments for low back pain evolve.

The viability of MRE-derived stiffness to provide an objective biomarker for intervertebral disc degeneration was demonstrated in a study published by Walter, Kolipaka and fellow Spine Research Institute researchers in the October 2017 issue of Radiology.

MR scan in operated intervertebral discs.Internal discontinuities in operated intervertebral discs shown via MRI imaging (left and middle), while the far-right image shows an MRE-derived measurement.

“We hope to be able to differentiate painful discs from asymptomatic discs,” explained Walter. “In addition to stratifying this disease process, we're hoping to use the technique to identify damage within the tissue that you can't see in a normal MRI.”

Currently, MRE technology is only used clinically to diagnose liver fibrosis. In order to make it viable for diagnosing IVD degeneration, the researchers aim to reduce the scanning time, validate the MRE-derived measurements and determine the limits of MRE-detection.

While this research project will focus on the intervertebral disc, the technique has the potential to examine and identify issues with the muscles that support the disc and other causes of low back pain.

“This technique has many potential applications within the spine, including the muscles, ligaments and joints, which can also be sources of low back pain,” said Walter.

The project is an interdisciplinary collaboration between researchers in the College of Engineering and College of Medicine. Other collaborators include Radiology Assistant Professor Dr. Daniel Boulter, Orthopaedics Associate Professor Dr. Safdar Khan, Center for Biostatics Biostatistician Brett Klamer, Radiology Assistant Professor Dr. Xuan Nguyen, Anesthesiology Assistant Professor Dr. Tristan Weaver, and Orthopaedics Associate Professor Dr. Elizabeth Yu. 

This research is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health

by Candi Clevenger, College of Engineering Communications, clevenger.87@osu.edu