The Study: The association between subgroups of MRI findings identified with latent class analysis and low back pain in 40-year-old Danes.
a. Disabling lower back pain puts an economic burden on society.
b. The authors indicate that there has not been much progress made toward knowing what is the best way to treat low back pain.
c. The authors note that although MRI is frequently used to look for things that might be causing low back pain, its use for that purpose is controversial because findings often have a weak correlation to lower back pain.
d. The authors looked at MRI finding of 631 patients which allowed analysis of 3155 motion segments.
e. They employed statistical analysis.
f. They noted that in the past, “Research into the clinical importance of spinal MRI findings in patients with low back pain (LBP) has primarily focused on single imaging findings, such as Modic changes or disc degeneration and found only weak associations with the presence of pain.” But they also stated, “It is possible that multiple MRI findings are more strongly associated with LBP than single MRI findings.”
g. In their conclusion they stated, “Although MRI findings are common in asymptomatic people and the association between single MRI findings and LBP is often weak, our results suggest that subgroups of multiple and severe lumbar MRI findings have a stronger association with LBP than those with milder degrees of degeneration.”
Single MRI findings often show a weak correlation to lower back pain. However this article indicates that multiple (or severe) findings may have a stronger correlation with low back pain.
This seems quite logical. At first glance, multiple or more severe findings would seem more likely to be associated with symptoms. I would like to note that supine MRIs tend to be a poor method to evaluate the spinal alignment that would be seen in upright imaging. In addition, in this study, the only real alignment factor for which they searched was anterolisthesis. I have concerns regarding the idea that anterolisthesis would even show up in its full form on a supine test since the involved segment(s) are under much greater stress as we move to an upright position. In short, an MRI is an important and useful test, but many patients have their most severe low back pain when in the upright position. Imaging that shows the spine in an upright position has significant advantages in seeing if the spine is structurally able to withstand the stress of gravity.
Reviewer: Roger Coleman DC
Editor: Mark R. Payne DC
Reference: Jensen RK, Kent P, Jensen TS, Kjaer P. The association between subgroups of MRI findings identified with latent class analysis and low back pain in 40-year-old Danes. BMC Musculoskelet Disord. 2018;19:62.
Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/29463258