Weishaupt D, Zanetti M, Hodler J, et al. Painful Lumbar Disk Derangement: Relevance of Endplate Abnormalities at MR Imaging

Departments of Radiology, Orthopaedic University Hospital Balgrist, Zurich, Switzerland.
Radiology (Impact Factor: 6.87). 03/2001; 218(2):420-7. DOI: 10.1148/radiology.218.2.r01fe15420
Source: PubMed


To investigate the predictive value of magnetic resonance (MR) imaging of abnormalities of the lumbar intervertebral disks, particularly with adjacent endplate changes, to predict symptomatic disk derangement, with discography as the standard.
Fifty patients aged 28-50 years with chronic low back pain and without radicular leg pain underwent prospective clinical examination and sagittal T1- and T2-weighted and transverse T2-weighted MR imaging. Subsequently, patients underwent lumbar discography with a pain provocation test (116 disks). MR images were evaluated for disk degeneration, a high-signal-intensity zone, and endplate abnormalities. Results of pain provocation at discography were rated independently of the image findings as concordant or as nonconcordant or painless. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the clinical relevance of MR abnormalities.
Normal disks on MR images were generally not painful at provocative discography (NPV, 98%). Disk degeneration (sensitivity, 98%; specificity, 59%; PPV, 63%) and a high-signal-intensity zone (sensitivity, 27%; specificity, 85%; PPV, 56%) were not helpful in the identification of symptomatic disk derangement. When only moderate and severe type I and type II endplate abnormalities were considered abnormal, all injected disks caused concordant pain with provocation (sensitivity, 38%; specificity, 100%; PPV, 100%).
Moderate and severe endplate abnormalities appear be useful in the prediction of painful disk derangement in patients with symptomatic low back pain.

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    • "The prevalence of VESC varies greatly among studies ranging from less than 1% in adolescents from the Danish general population [22] to 100% in selected patient populations [23]. Some studies observed an association between VESC and back pain [24] [25] [26] [27], whereas other studies did not observe any association [28] [29] [30] [31]. Studies correlating VESC on consecutive MRIs in patients with sciatica are limited, especially studies comparing surgery with conservative treatment for the development of VESC. "
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