Apparent diffusion in nucleus pulposus is associated with pain and mobility improvements after spinal mobilization for acute low back pain

TL;DR

This study shows that spinal mobilization in acute low back pain patients increases water diffusion in the nucleus pulposus, correlating with pain reduction and improved trunk mobility, indicating a potential mechanism for pain relief.

Contribution

It demonstrates a link between increased apparent diffusion coefficient in the nucleus pulposus and clinical improvements after mobilization in acute low back pain.

Findings

Pain significantly reduced after mobilization.

Trunk mobility significantly increased.

ADC values in nucleus pulposus increased, especially at L3-L4 and L4-L5 levels.

Abstract

Pain perception, trunk mobility in flexion, extension, and lateral flexion, and apparent diffusion coefficient (ADC) within nucleus pulposus of all lumbar discs were collected before and after posterior-to-anterior mobilization in 16 adults with acute low back pain. ADC was computed from diffusion maps and 3 specific portions of the nucleus pulposus were investigated: anterior (ADCant ), middle (ADCmid), and posterior (ADCpost ), and their mean as ADCall , a summary measure of ADC within nucleus pulposus. Pain ratings were significantly reduced after mobilization, and mobility of the trunk was significantly increased. Concomitantly, a significant increase in ADCall values was observed. The greatest ADCall changes were observed at the L3-L4 and L4-L5 levels and were mainly explained by changes in ADCant and ADCpost . The simultaneous reduction in pain and increase of water diffusion within nucleus pulposus has has been previously observed in subjects with chronic conditions and exists in the acute phase of the disease. Since the largest changes in ADC were observed at the periphery of the nucleus pulposus, and taken together with pain decrease, our results suggest that increased peripheral random motion of water molecules is implicated in the modulation of the intervertebral disc nociceptive response.