Document Detail

Degenerative magnetic resonance imaging changes in patients with chronic low back pain: a systematic review.
MedLine Citation:
PMID:  21952189     Owner:  NLM     Status:  MEDLINE    
STUDY DESIGN: Systematic review.
OBJECTIVE: To systematically search for critically appraise and summarize studies that (1) evaluated the association between degenerative magnetic resonance imaging (MRI) changes and chronic low back pain (CLBP) and (2) compared surgical and nonsurgical treatment of these degenerative MRI changes.
SUMMARY OF BACKGROUND DATA: The role of routine MRI in patients with CLBP is unclear. It is also uncertain whether or not surgical treatment of degenerative MRI changes results in alleviation of back pain.
METHODS: Systematic literature searches were conducted in PubMed for studies published through March 1, 2011. To evaluate whether MRI degenerative changes are associated with CLBP, studies that were designed to compare the prevalence of MRI changes among subjects with and without CLBP were sought. The prevalence odds ratio was used to compare the odds of degenerative MRI findings in subjects with CLBP to the odds of such findings among those without CLBP. To evaluate whether surgical treatment of degenerative MRI changes is associated with different outcomes compared with nonsurgical treatment, comparative studies were sought. The GRADE system as applied to describe the strength of the overall body of evidence.
RESULTS: Regarding the association of degenerative changes on MRI and CLBP, five studies were included, all of which were cross-sectional in design. On the basis of these studies, a statistically significant association was found in all but one study regarding the presence of disc degeneration and CLBP (odds ratio range: 1.8-2.8). The overall strength of evidence across studies was considered to be insufficient, however. No comparative studies of surgical versus nonsurgical treatment of degenerative MRI changes were identified.
CONCLUSION: Although there may be an association between degenerative MRI changes and CLBP, it is unknown if these estimates accurately represent the association given the quality of included studies, lack of a direct link between degenerative MRI changes and CLBP, and heterogeneity across studies. Thus, a strong recommendation against the routine use of MRI for CLBP evaluation is made. Since there are no data evaluating the efficacy of the surgical treatment of degenerative MRI changes, a strong recommendation is made against the surgical treatment of CLBP based solely upon degenerative MRI changes.
RECOMMENDATION 1: There is insuffi cient evidence to support the routine use of MRI in patients with CLBP.
RECOMMENDATION: Strong RECOMMENDATION 2: Surgical treatment of CLBP based exclusively on MRI fi ndings of degenerative changes is not recommended.
Dean Chou; Dino Samartzis; Carlo Bellabarba; Alpesh Patel; Keith D K Luk; Jeannette M Schenk Kisser; Andrea C Skelly
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Spine     Volume:  36     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-09-28     Completed Date:  2012-01-20     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S43-53     Citation Subset:  IM    
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MeSH Terms
Chronic Pain / diagnosis*,  etiology,  pathology,  surgery
Evidence-Based Medicine
Low Back Pain / diagnosis*,  etiology,  pathology,  surgery
Magnetic Resonance Imaging*
Odds Ratio
Orthopedic Procedures
Pain Measurement
Patient Selection
Practice Guidelines as Topic
Predictive Value of Tests
Risk Assessment
Risk Factors
Severity of Illness Index
Spine / pathology*,  surgery
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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