» MRI Not a Good Predictor of Low Back Pain

MRI Not a Good Predictor of Low Back Pain

MRI Not a Good Predictor of Low Back Pain

It's a well-known fact that low back pain (LBP) occurs in people with no obvious problems seen on X-ray or MRI. And it's also true that people with degenerative changes seen on imaging studies often have no symptoms at all. It would be helpful if people could have a baseline MRI done and kept on file. Then, if back problems come up, a second MRI could be done to compare any changes that have occured.

That's exactly what they did in this observational study. Baseline X-rays and MRIs were taken of 200 subjects who were then followed for five years. No one was disabled or had a previous history of back pain. All were working but had a known increased risk of LBP.

Anyone in the group who had a first-time episode of LBP had new imaging studies done within six to 12 weeks of their symptoms. The authors report the following findings:

  • One-fourth of the 200 patients developed LBP during the five-year study period
  • Most (84 per cent) had no changes seen on the second MRI.
  • Changes observed were all related to gradual degeneration from age.
  • Patients involved in compensation claims were three times more likely to have an MRI when LBP occurs.
  • It didn't matter if the LBP started after trauma or injury or just came on
    without a known cause. New findings weren't any more likely with one or the other.

    The results of this study do not support the idea that structural injury occurs with LBP even after trauma. It's more likely that minor trauma adds to injury already present in the aging and degenerative spine.

    MRI findings are not good predictors of future episodes of LBP. Other studies support the idea that psychosocial factors are much better predictors of significant low back problems.

    Eugene Carragee, MD, et al. Are First-Time Episodes of Serious LBP Associated with New MRI Findings? In The Spine Journal. November 2006. Vol. 6. No. 6. Pp. 624-635.

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