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The Value of Magnetic Resonance Imaging of the Lumbar Spine to Predict Low-Back Pain in Asymptomatic Subjects

A Seven-Year Follow-up Study

Investigation performed at the Division of Rheumatology, George Washington University Medical Center andthe Departments of Orthopaedic Surgery and Radiology, Georgetown University Medical Center, Washington, DC, and at the Department of Orthopaedic Surgery, The Emory Spine Center, Decatur, Georgia
David G. Borenstein, MD
Alan Jacobson, MD
Division of Rheumatology, George Washington University Medical Center, 2150 Pennsylvania Avenue N.W., Washington, DC 20037

James W. O’Mara Jr., MD
William C. Lauerman, MD
Sam W. Wiesel, MD
Craig Platenberg, MD
Dieter Schellinger, MD
Departments of Orthopaedic Surgery (J.W.O’M. Jr., W.C.L., and S.W.W.) and Radiology (C.P. and D.S.), Georgetown University Medical Center, 3800 Reservoir Road N.W., Washington, DC 20007

Scott D. Boden, MD
Department of Orthopaedic Surgery, The Emory Spine Center, 2165 North Decatur Road, Decatur, GA 30033

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

Background: In 1989, a group of sixty-seven asymptomatic individuals with no history of back pain underwent magnetic resonance imaging of the lumbar spine. Twenty-one subjects (31%) had an identifiable abnormality of a disc or of the spinal canal. In the current study, we investigated whether the findings on the scans of the lumbar spine that had been made in 1989 predicted the development of low-back pain in these asymptomatic subjects.

Methods: A questionnaire concerning the development and duration of low-back pain over a seven-year period was sent to the sixty-seven asymptomatic individuals from the 1989 study. A total of fifty subjects completed and returned the questionnaire. A repeat magnetic resonance scan was made for thirty-one of these subjects. Two neuroradiologists and one orthopaedic spine surgeon interpreted the original and repeat scans in a blinded fashion, independent of clinical information. At each disc level, any radiographic abnormality, including bulging or degeneration of the disc, was identified. Radiographic 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 during the seven-year study period. The 1989 scans of these subjects demonstrated 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 greater frequency of disc herniation, bulging, degeneration, and spinal stenosis than did the original scans.

Conclusions: The findings on magnetic resonance scans were not predictive of the development or duration of low-back pain. Individuals with the longest 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.

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