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Magnetic Resonance Imaging and Low Back Pain in Adults: A Diagnostic Imaging Study of 40-Year-Old Men and Women

Kjaer, Per, PT, MSc, PhD*; Leboeuf-Yde, Charlotte, DC, MPH, PhD*; Korsholm, Lars, PhD; Sorensen, Joan Solgaard, MD*; Bendix, Tom, MD, Dr Med Sci*

doi: 10.1097/01.brs.0000162396.97739.76

Study Design. Cross-sectional cohort study of a general population.

Objective. To investigate “abnormal” lumbar spine magnetic resonance imaging (MRI) findings, and their prevalence and associations with low back pain (LBP).

Summary of Background Data. The clinical relevance of various “abnormal” findings in the lumbar spine is unclear. Distinguishing between inevitable age-related findings and degenerative findings with deleterious consequences is a challenge.

Methods. Lumbar spine MRI was obtained in 412, 40-year-old individuals. Predefined “abnormal” MRI findings were interpreted without any knowledge of patient symptoms. Associations between MRI abnormalities and LBP were calculated using odds ratios. The “overall picture” of each MRI finding was established on the basis of the frequencies, diagnostic values, and the strength and consistency of associations.

Results. Most “abnormal” MRI findings were found at the lowest lumbar levels. Irregular nucleus shape and reduced disc height were common (>50% of individuals). Relatively common (25% to 50%) were hypointense disc signal, anular tears, high intensity zones, disc protrusions, endplate changes, zygapophyseal joint degeneration, asymmetry, and foraminal stenosis. Nerve root compromise, Modic changes, central spinal stenosis, and anterolisthesis/retrolisthesis were rare (<25%). Most strongly associated with LBP were Modic changes and anterolisthesis (odds ratios >4). Significantly positive associations with all LBP variables were seen for hypointense disc signals, reduced disc height, and Modic changes. All disc “abnormalities” except protrusion were moderately associated with LBP during the past year.

Conclusion. Most degenerative disc “abnormalities” were moderately associated with LBP. The strongest associations were noted for Modic changes and anterolisthesis. Further studies are needed to define clinical relevance.

The clinical relevance of magnetic resonance imaging findings in relation to low back pain (LBP) is frequently debated. A large cohort study of the general population was conducted, and associations between magnetic resonance imaging findings and LBP were investigated. Modic changes appeared to be highly associated to LBP followed by degenerative disc findings.

From *The Back Research Center, Backcenter Funen, Ringe, and University of Southern Denmark, and †Department of Statistics, University of Southern Denmark, Odens, Denmark.

Acknowledgment date: December 18, 2003. First revision date: May 10, 2004. Acceptance date: June 30, 2004.

Supported by Industrial Insurance Company (now TopDenmark).

The manuscript submitted does not contain information about medical device(s)/drug(s).

Corporate/Industry funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Per Kjaer, PT, MSc, PhD, The Back Research Center, Backcenter Funen and University of Southern Denmark, Lindevej 5, DK-5750 Ringe, Denmark; E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.