The Journal of Bone and Joint Surgery (American) 83:1306-1311 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
The Value of Magnetic Resonance Imaging of the Lumbar Spine to Predict Low-Back Pain in Asymptomatic Subjects
A Seven-Year Follow-up Study
David G. Borenstein, MD,
James W. O'Mara, Jr, MD,
Scott D. Boden, MD,
William C. Lauerman, MD,
Alan Jacobson, MD,
Craig Platenberg, MD,
Dieter Schellinger, MD and
Sam W. Wiesel, MD
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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