Article

Predictors of long-term pain and disability in patients with low back pain investigated by magnetic resonance imaging: a longitudinal study.

MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. .
BMC Musculoskeletal Disorders (Impact Factor: 1.88). 01/2011; 12:234. DOI: 10.1186/1471-2474-12-234
Source: PubMed

ABSTRACT It is possible that clinical outcome of low back pain (LBP) differs according to the presence or absence of spinal abnormalities on magnetic resonance imaging (MRI), in which case there could be value in using MRI findings to refine case definition of LBP in epidemiological research. We therefore conducted a longitudinal study to explore whether spinal abnormalities on MRI for LBP predict prognosis after 18 months.
A consecutive series of patients aged 20-64 years, who were investigated by MRI because of mechanical LBP (median duration of current episode 16.2 months), were identified from three radiology departments, and those who agreed completed self-administered questionnaires at baseline and after a mean follow-up period of 18.5 months (a mean of 22.2 months from MRI investigation). MRI scans were assessed blind to other clinical information, according to a standardised protocol. Associations of baseline MRI findings with pain and disability at follow-up, adjusted for treatment and for other potentially confounding variables, were assessed by Poisson regression and summarised by prevalence ratios (PRs) with their 95% confidence intervals (CIs).
Questionnaires were completed by 240 (74%) of the patients who had agreed to be followed up. Among these 111 men and 129 women, 175 (73%) reported LBP in the past four weeks, 89 (37%) frequent LBP, and 72 (30%) disabling LBP. In patients with initial disc degeneration there was an increased risk of frequent (PR 1.3, 95%CI 1.0-1.9) and disabling LBP (PR 1.7, 95%CI 1.1-2.5) at follow-up. No other associations were found between MRI abnormalities and subsequent outcome.
Our findings suggest that the MRI abnormalities examined are not major predictors of outcome in patients with LBP. They give no support to the use of MRI findings as a way of refining case definition for LBP in epidemiological research.

0 Bookmarks
 · 
131 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background and Objective: Magnetic resonance imaging (MRI) has the potential to identify pathology responsible for low back pain (LBP). However, the importance of findings on MRI remains controversial. We aimed to systematically review whether MRI findings of the lumbar spine predict future LBP in different samples with and without LBP. Databases and Data Treatment: MEDLINE, CINAHL and EMBASE databases were searched. Included were prospective cohort studies investigating the relationship between baseline MRI abnormalities of the lumbar spine and clinically important LBP outcome at follow-up. We excluded cohorts with specific diseases as the cause of their LBP. Associations between MRI findings and LBP pain outcomes were extracted from eligible studies. Results: A total of 12 studies met the inclusion criteria. Six studies presented data on participants with current LBP; one included a sample with no current LBP, three included a sample with no history of LBP and two included mixed samples. Due to small sample size, poor overall quality and the heterogeneity between studies in terms of participants, MRI findings and clinical outcomes investigated, it was not possible to pool findings. No consistent associations between MRI findings and outcomes were identified. Single studies reported significant associations for Modic changes type 1 with pain, disc degeneration with disability in samples with current LBP and disc herniation with pain in a mixed sample. Conclusions: The limited number, heterogeneity and overall quality of the studies do not permit definite conclusions on the association of MRI findings of the lumbar spine with future LBP (PROSPERO: CRD42012002342).
    European journal of pain (London, England) 10/2013; · 3.37 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This is the case report of a 79 year old female patient (Mrs X), referred for assessment and osteopathic treatment of her left shoulder pain and restricted range of motion. Seven months later Mrs X was diagnosed with left hemi Parkinson’s disease (PD). The report reflects on whether or not the left shoulder signs and symptoms were prodromal of PD, the diagnostic reasoning and evaluation of this patient prior to the diagnosis of PD, the challenges to musculoskeletal practitioners associated with potential prodromal musculoskeletal presentations of PD and the prospect of increasing numbers of such presentations with the projected rise in PD cases in years to come.
    International Journal of Osteopathic Medicine 01/2014; · 0.58 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Diagnosis of lumbar spinal stenosis (LSS) is based on clinical examination and imaging. The aim of this study was to evaluate the influence of 3D gait analysis as a tool in the differential diagnosis of LSS. Fourteen patients participated in the study that consisted of three phases: 1) Capture six gait cycles after rest, 2) Walk on a treadmill for a maximum of twenty minutes, 3) Capture six gait cycles after effort. From these data, the kinematic variables were compared with the perception of pain and the cross sectional area of the spinal canal as measured by magnetic resonance. Most of correlations were weak and showed that the most significant results are reported by the gait deviation index (GDI). The gait deviation index demonstrated moderate negative correlation with the perception of pain after effort was made by both limbs. This means that there is a significant decrease in the overall function of the lower limbs according to the increase in pain symptoms. This situation may be reflected in decreased cadence and speed beyond the times of single support for the left limb, and the balance of the right limb, as part of a strategy to protect against pain and imbalance. We found no correlation between gait and pain in the cross-sectional area of the spinal canal. Therefore, we believe that there is no advantage for the patient to make a 3-D gait analysis because the analysis does not add relevant information to clinical diagnosis.
    Gait & posture 04/2014; · 2.58 Impact Factor

Full-text (2 Sources)

View
1 Download
Available from