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More MRI findings increase the likelihood of recent or recurrent back pain
Clinical Question
Is there an association between the number of magnetic resonance imaging findings and low back pain?
Bottom line
Magnetic resonance imaging (MRI) findings aren't completely useless to predict low back pain. That patient with the long list of abnormalities is more likely to have back problems than the patient with just a single finding or a normal result. 2b
Reference
Study design: Cross-sectional
Funding: Other
Setting: Outpatient (any)
Synopsis
We know that the association between any single abnormality on an MRI and low back pain is weak at best. Some patients have a great deal of pain and no findings, or findings in the "wrong" place on their MRI, while others have abnormalities on MRI but no pain in that anatomic distribution. These researchers used 2 datasets to dig deeper into this question. The first cross-sectional dataset included 412 Danes who were asked about whether they had back pain in the past year (69% had), and who also underwent MRI of the lower back. The second was a group of 76 persons in Australia who recently recovered from an episode of low back pain, and who were followed up for 12 months to see if they had a recurrence (39% did). In the cross-sectional group, the likelihood of low back pain increased with an increasing number of findings: the adjusted odds ratio was 2.0 for 1 finding, 3.9 for 2 findings, and 14.6 for 3 to 4 findings. The same thing was true regarding recurrence, with adjusted odds ratios of 3.3, 8.6, and 24.0, respectively, for 1, 2, or 3 findings compared with no findings. In absolute terms, the rate of recurrence over 1 year was 11%, 29%, 52%, and 75% for patients with 0, 1, 2, or 3 MRI findings, respectively. Some findings were relatively nonpredictive, such as the presence of facet joint osteoarthritis. Spondylolisthesis and modic changes to bone, however, strongly predicted back pain in the previous year, and disc height loss and degenerative disc changes predicted recurrence.
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Comments
The presentation here is too short I hope I find full article and similer article , this is the the question most of my patients aske after mri , but my exprince is different in 30 yrs practice very few patient with non surgical mri finding had recurrence of pain .
This is of no practical use to me as a radiologist, or of use to my referring physician. It simply highlights the need for some kind of clinical correlation with the multiple findings we see in older patients
What is the point of this study? Can't you just find out if people have had back pain by taking a history? I would like to know more about who funded this study. It looks suspiciously like promotional material from an MRI company. It looks like the sort of study that would prompt people to come in and demand an expensive, rationed test with results adding little to clinical management or outcome.
This will help to justify ordering MRI to be sure of the diagnosis at a time when the government is limiting the availability and payment of MRI for back pain
really!!!!!
is it because they now know that there is something on these test that anything they fell will be associated with the fact that they have something ...while before they would just not have pay attention to it and life would go on .
So...
Were patients made aware of the findings ? ie is this saying that tif the patients are told there are more findings they are more likely to feel more symptoms, or is it implying that MRI findings are predictive of future back pain ? And if the later will it change our management - like will it convince them to do their exercises ?
Good poem
Les investigation avec IRM n'ajoute rien de plus pour la majorité des douleurs lombaires mais répondent à la pression des patients que c'est le meilleur outil de diagnostic . L'histoire clinique est souvent suffisante pour déterminer le type de douleur lombaire. Parfois le simple RX confirme l'arthrose, les rétrécissements intervertébraux et les hernies possibles.
This is a great paper. Thanks.
I can see where the presence of modic changes, which usually means discitis or osteomyelitis would indicate the presence of low back pain, as would spondylolisthesis. Degenerative disc disease is usually associated with age which results in loss of collagen (when it is lost under the skin, there are wrinkles, in the musculoskeletal system, it results in herniated discs, osteoarthritis and ligamentous laxity). Ligamentous laxity resulting in sprains of the sacroiliac joints is the commonest cause of low back pain and is easy to diagnose and treat, but it is not visible on MRI. https://www.youtube.com/watch?v=NXNS6PNKRPo
This is a poorly written article, and I am not sure what conclusion I am supposed to draw from it. It seems to go against the Choosing Wisely Guidelines that suggest MRIs are of limited use in for patients with back pain.
Not useful and no surprise. Predicting back pain is straightforward but treatment is another question. MRI would be useful if it helped with treatment.
What can we do with this information?