Abstract
BackgroundIt is possible that clinical outcome of low back pain (LBP) differs according to the presence or absence of spinal abnormalities on magnetic resonance imaging (MRI), in which case there could be value in using MRI findings to refine case definition of LBP in epidemiological research. We therefore conducted a longitudinal study to explore whether spinal abnormalities on MRI for LBP predict prognosis after 18 months.MethodsA consecutive series of patients aged 20-64 years, who were investigated by MRI because of mechanical LBP (median duration of current episode 16.2 months), were identified from three radiology departments, and those who agreed completed self-administered questionnaires at baseline and after a mean follow-up period of 18.5 months (a mean of 22.2 months from MRI investigation). MRI scans were assessed blind to other clinical information, according to a standardised protocol. Associations of baseline MRI findings with pain and disability at follow-up, adjusted for treatment and for other potentially confounding variables, were assessed by Poisson regression and summarised by prevalence ratios (PRs) with their 95% confidence intervals (CIs).ResultsQuestionnaires were completed by 240 (74%) of the patients who had agreed to be followed up. Among these 111 men and 129 women, 175 (73%) reported LBP in the past four weeks, 89 (37%) frequent LBP, and 72 (30%) disabling LBP. In patients with initial disc degeneration there was an increased risk of frequent (PR 1.3, 95%CI 1.0-1.9) and disabling LBP (PR 1.7, 95%CI 1.1-2.5) at follow-up. No other associations were found between MRI abnormalities and subsequent outcome.ConclusionsOur findings suggest that the MRI abnormalities examined are not major predictors of outcome in patients with LBP. They give no support to the use of MRI findings as a way of refining case definition for LBP in epidemiological research.
Highlights
It is possible that clinical outcome of low back pain (LBP) differs according to the presence or absence of spinal abnormalities on magnetic resonance imaging (MRI), in which case there could be value in usingMRI findings to refine case definition of LBP in epidemiological research
They give no support to the use of MRI findings as a way of refining case definition for LBP in epidemiological research
LBP is often treated as a single diagnostic entity, but in theory there might be advantages in distinguishing cases that are associated with specific pathology in the spine
Summary
It is possible that clinical outcome of low back pain (LBP) differs according to the presence or absence of spinal abnormalities on magnetic resonance imaging (MRI), in which case there could be value in usingMRI findings to refine case definition of LBP in epidemiological research. Full list of author information is available at the end of the article prognosis for LBP differed importantly according to the presence or absence MRI abnormalities, there could be value in using MRI findings to refine case definitions for the disorder in epidemiological research. We recently compared clinical presentations and associations with risk factors in patients with LBP who were investigated by MRI, according to whether specified spinal abnormalities were observed. Those with nerve root deviation or compression were more likely to report radiation of their pain to below the knee and associated neurological symptoms in the leg [2]. There was no clear difference between cases with and without spinal pathology
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