Imaging of the Lumbar Spine – What Does It Really Tell Us?

Screen Shot 2014-02-28 at 3.55.44 PMPreviously, I’ve written on the knowledge of MRI results and its impact on treatment outcomes. Results of a study by Modic et al. found no prognostic value of MRI over that of the clinical assessment. Size, type, and location of disc herniations were not associated with outcome.  At the six-week follow-up, improvements were not significantly different between groups that knew the results of their MRI and those that did not.  One of the more interesting findings of that study was that those who knew their MRI results had a lesser sense of well-being despite similar outcomes to those without knowledge of their imaging.  This supports the importance of  medical professionals emphasizing that patients not obsess with results of imaging and instead focus improvements in functional status.

Further research looking at the results of imagining of the lumbar spine provides further evidence for the medical community to be more cautious in their reliance on imaging. Wtt, Vestergaard, and Rosenklint compared X-rays of people with lumbar spine and sciatic pain to those without low back pain. Their results found no significant differences in the X-rays between these two groups in regards to disc degeneration and spondylosis. Boden et al. took MRIs of participants without history of lumbar spine pain. In their asymptomatic patients under the age of 60, 20% had at least one disc herniation. 57% of participants over the age of 60 had abnormal findings. Middleton and Fish reported disc protrusions in 80% and spinal stenosis in 20% of asymptomatic individuals over the age of 60. They also provided evidence for significant levels of disc degeneration in asymptomatic women in their twenties.

Screen Shot 2014-02-28 at 3.55.35 PMJensen and colleagues reported that of asymptomatic participants in their study, 36% had normal lumbar discs on MRI, 52% had at least one disc bulge, 27% had a disc protrusion, 1% had an extrusion, 38% had more than one level of abnormality. They concluded their article stating that “given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.”

Please don’t mistake these results as proof that imaging is worthless as it very frequently is needed in the treatment of back pain. Instead, us this research as evidence in the education of patients who worry about their long term quality of life following diagnosis following imaging.

References

  • Wtt, Vestergaard, & Rosenklint. A Comparative Analysis of X-ray Findings of the Lumbar Spine in Patients With and Without Lumbar Pain.
  • Boden, Davis, Patronas, & Wiesel. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation.
  • Middleton & Fish. Lumbar spondylosis: clinical presentation and treatment approaches.
  • Jensen, Brant-Zawadzki, Obuchowski, Modic, Malkasian, & Ross. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain.
  • Modic, Obuchowski, Ross, Brant-Zawadzki, Grooff, Mazanec, Benzel (2005). Acute Low Back Pain and Radiculopathy: MR Imaging Findings and Their Prognostic Role and Effect on Outcome.  Radiology, 237.

  One thought on “Imaging of the Lumbar Spine – What Does It Really Tell Us?

  1. Jeancarlo Alencastro
    November 23, 2015 at 6:48 pm

    MRI results of the lumbar spine with my experience do not relate to the amount of pain or lack thereof a patient has. I’ve seen positive results using extension biased exercises centralizing radiating symptoms on patients who would later request MRI’s showing retro spondylolisthesis at L5-S1. You would assume extension bias would worsen or cause symptoms with spondylolisthesis as it further narrows the spinal canal.

    • November 23, 2015 at 6:52 pm

      Absolutely. I see that so frequently too! Treat based on movement response not imaging!

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