Dg. Borenstein et al., The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects - A seven-year follow-up study, J BONE-AM V, 83A(9), 2001, pp. 1306-1311
Ortopedics, Rehabilitation & Sport Medicine","da verificare
Background: In 1989, a group of sixty-seven asymptomatic individuals with n
o history of back pain underwent magnetic resonance imaging of the lumbar s
pine. Twenty-one subjects (31%) had an identifiable abnormality of a disc o
r of the spinal canal. In the current study, we investigated whether the fi
ndings on the scans of the lumbar spine that had been made in 1989 predicte
d the development of low-back pain in these asymptomatic subjects.
Methods: A questionnaire concerning the development and duration of low-bac
k pain over a seven-year period was sent to the sixty-seven asymptomatic in
dividuals from the 1989 study. A total of fifty subjects completed and retu
rned the questionnaire. A repeat magnetic resonance scan was made for thirt
y-one of these subjects. Two neuroradiologists and one orthopaedic spine su
rgeon interpreted the original and repeat scans in a blinded fashion, indep
endent of clinical information. At each disc level, any radiographic abnorm
ality, including bulging or degeneration of the disc, was identified. Radio
graphic progression was defined as increasing severity of an abnormality at
a specific disc level or the involvement of additional levels.
Results: Of the fifty subjects who returned the questionnaire, twenty-nine
(58%) had no back pain. Low-back pain developed in twenty-one subjects duri
ng the seven-year study period. The :1989 scans of these subjects demonstra
ted normal findings in twelve, a herniated disc in five, stenosis in three,
and moderate disc degeneration in one. Eight individuals had radiating leg
pain; four of them had had normal findings on the original scans, two had
had spinal stenosis, one had had a disc protrusion, and one had had a disc
extrusion. In general, repeat magnetic resonance imaging scans revealed a g
reater frequency of disc herniation, bulging, degeneration, and spinal sten
osis than did the original scans.
Conclusions: The findings on magnetic resonance scans were not predictive o
f the development or duration of low-back pain. Individuals with the longes
t duration of low-back pain did not have the greatest degree of anatomical
abnormality on the original, 1989 scans. Clinical correlation is essential
to determine the importance of abnormalities on magnetic resonance images.