Top

Published in:

01-02-2012 | Review Article

Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review

Authors: Merel Wassenaar, Rogier M. van Rijn, Maurits W. van Tulder, Arianne P. Verhagen, Danielle A. W. M. van der Windt, Bart W. Koes, Michiel R. de Boer, Abida Z. Ginai, Raymond W. J. G. Ostelo

Published in: European Spine Journal | Issue 2/2012

Abstract

Purpose

In about 5% of all cases LBP is associated with serious underlying pathology requiring diagnostic confirmation and directed treatment. Magnetic resonance imaging (MRI) is often used for this diagnostic purpose yet its role remains controversial. Consequently, this review aimed to summarize the available evidence on the diagnostic accuracy of MRI for identifying lumbar spinal pathology in adult low back pain (LPB) or sciatica patients.

Methods

MEDLINE, EMBASE and CINAHL were searched (until December 2009) for observational studies assessing the diagnostic accuracy of MRI compared to a reference test for the identification of lumbar spinal pathology. Two reviewers independently selected studies for inclusion, extracted data and assessed methodological quality. Pooled summary estimates of sensitivity and specificity with 95% confidence intervals were calculated for homogenous subsets of studies.

Results

Eight studies were included in this review. Strata were defined for separate pathologies i.e. lumbar disc herniation (HNP) and spinal stenosis. Five studies comparing MRI to findings at the surgery for identifying HNP were included in a meta-analysis. Pooled analysis resulted in a summary estimate of sensitivity of 75% (95% CI 65–83%) and specificity of 77% (95% CI 61–88%). For spinal stenosis pooling was not possible.

Conclusions

The results suggest that a considerable proportion of patients may be classified incorrectly by MRI for HNP and spinal stenosis. However, the evidence for the diagnostic accuracy of MRI found by this review is not conclusive, since the results could be distorted due to the limited number of studies and large heterogeneity.

Burton AK, Balague F, Cardon G et al (2006) Chapter 2. European guidelines for prevention in low back pain: November 2004. Eur Spine J 15(Suppl 2):S136–S168PubMedCrossRef

Ehrlich GE (2003) Low back pain 45. Bull World Health Organ 81:671–676PubMed

Elders LA, Burdorf A (2004) Prevalence, incidence, and recurrence of low back pain in scaffolders during a 3-year follow-up study 42. Spine (Phila Pa 1976.) 29:E101–E106CrossRef

Chou R, Qaseem A, Snow V et al (2007) Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 147:478–491PubMed

van TM, Becker A, Bekkering T et al (2006) Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 15(Suppl 2):S169–S191

Kendrick D, Fielding K, Bentley E et al (2001) Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. BMJ 322:400–405PubMedCrossRef

Ash LM, Modic MT, Obuchowski NA et al (2008) Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR Am J Neuroradiol 29:1098–1103PubMedCrossRef

Loblaw DA, Perry J, Chambers A et al (2005) Systematic review of the diagnosis and management of malignant extradural spinal cord compression: the Cancer Care Ontario Practice Guidelines Initiative’s Neuro-Oncology Disease Site Group 13. J Clin Oncol 23:2028–2037PubMedCrossRef

Tsiodras S, Falagas ME (2006) Clinical assessment and medical treatment of spine infections. Clin Orthop Relat Res 444:38–50PubMedCrossRef

10.

Jarvik JG, Deyo RA (2002) Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med 137:586–597PubMed

11.

Deyo RA, Bigos SJ, Maravilla KR (1989) Diagnostic imaging procedures for the lumbar spine. Ann Intern Med 111:865–867PubMed

12.

Ozturk C, Karadereler S, Ornek I et al (2010) The role of routine magnetic resonance imaging in the preoperative evaluation of adolescent idiopathic scoliosis. Int Orthop 34:543–546PubMedCrossRef

13.

Chou R, Fu R, Carrino JA et al (2009) Imaging strategies for low-back pain: systematic review and meta-analysis 9. Lancet 373:463–472PubMedCrossRef

14.

Jarvik JG, Hollingworth W, Martin B et al (2003) Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial. JAMA 289:2810–2818PubMedCrossRef

15.

Lurie JD, Birkmeyer NJ, Weinstein JN (2003) Rates of advanced spinal imaging and spine surgery. Spine (Phila Pa 1976.) 28:616–620

16.

Thornbury JR, Fryback DG, Turski PA et al (1993) Disk-caused nerve compression in patients with acute low back pain: diagnosis with MR, CT myelography and plain CT. Radiology 186:731–738PubMed

17.

Jensen MC, Brant-Zawadzki MN, Obuchowski N et al (1994) Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 331:69–73PubMedCrossRef

18.

van Tulder MW, Assendelft WJ, Koes BW et al (1997) Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies. Spine (Phila Pa 1976.) 22:427–434CrossRef

19.

Smidt N, Deeks J, Moore T (2005) Cochrane Handbook for Cochrane Reviews of Diagnostic Test Accuracy. The Cochrane Collaboration. Ref Type: Generic

20.

Whiting P, Rutjes AW, Dinnes J et al (2004) Development and validation of methods for assessing the quality of diagnostic accuracy studies. Health Technol Assess 8:iii1–iii234

21.

Juni P, Witschi A, Bloch R et al (1999) The hazards of scoring the quality of clinical trials for meta-analysis. JAMA 282:1054–1060PubMedCrossRef

22.

Whiting P, Harbord R, Kleijnen J (2005) No role for quality scores in systematic reviews of diagnostic accuracy studies. BMC Med Res Methodol. 5:19PubMedCrossRef

23.

Reitsma JB, Glas AS, Rutjes AW et al (2005) Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 58:982–990PubMedCrossRef

24.

Bernard TN Jr (1994) Using computed tomography/discography and enhanced magnetic resonance imaging to distinguish between scar tissue and recurrent lumbar disc herniation. Spine (Phila Pa 1976.) 19:2826–2832CrossRef

25.

Birney TJ, White JJ Jr, Berens D et al (1992) Comparison of MRI and discography in the diagnosis of lumbar degenerative disc disease. J Spinal Disord 5:417–423PubMedCrossRef

26.

Bischoff RJ, Rodriguez RP, Gupta K et al (1993) A comparison of computed tomography-myelography, magnetic resonance imaging, and myelography in the diagnosis of herniated nucleus pulposus and spinal stenosis. J Spinal Disord 6:289–295PubMedCrossRef

27.

Chawalparit O, Churojana A, Chiewvit P et al (2006) The limited protocol MRI in diagnosis of lumbar disc herniation. J Med Assoc Thai 89:182–189PubMed

28.

Forristall RM, Marsh HO, Pay NT (1988) Magnetic resonance imaging and contrast CT of the lumbar spine. comparison of diagnostic methods and correlation with surgical findings. Spine (Phila Pa 1976.) 13:1049–1054CrossRef

29.

Jackson RP, Cain JE Jr, Jacobs RR et al (1989) The neuroradiographic diagnosis of lumbar herniated nucleus pulposus: II. a comparison of computed tomography (CT), myelography, CT-myelography, and magnetic resonance imaging. Spine (Phila Pa 1976.) 14:1362–1367CrossRef

30.

Aota Y, Niwa T, Yoshikawa K et al (2007) Magnetic resonance imaging and magnetic resonance myelography in the presurgical diagnosis of lumbar foraminal stenosis. Spine (Phila Pa 1976.) 32:896–903CrossRef

31.

Diamond GA (1992) Off Bayes: effect of verification bias on posterior probabilities calculated using Bayes’ theorem 5. Med Decis.Making 12:22–31PubMedCrossRef

32.

Mol BW, Lijmer JG, van der MJ et al (1999) Effect of study design on the association between nuchal translucency measurement and Down syndrome. Obstet Gynecol 94:864–869PubMedCrossRef

33.

Jacobsen S, Gosvig KK, Sonne-Holm S (2006) Low back degeneration and radiology. Ugeskr.Laeger 168:769–773PubMed

34.

Leeflang MM, Deeks JJ, Gatsonis C et al (2008) Systematic reviews of diagnostic test accuracy. Ann Intern Med 149:889–897PubMed

Title: Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review
Authors: Merel Wassenaar
Rogier M. van Rijn
Maurits W. van Tulder
Arianne P. Verhagen
Danielle A. W. M. van der Windt
Bart W. Koes
Michiel R. de Boer
Abida Z. Ginai
Raymond W. J. G. Ostelo
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 2/2012
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-011-2019-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2012

MRI findings are more common in selected patients with acute low back pain than controls?

Remodeling of adjacent spinal alignments following cervical arthroplasty and anterior discectomy and fusion

Occipital condyle fractures. Prospective follow-up of 31 cases within 5 years at a level 1 trauma centre

Evaluation of the rate of decompression in anterior cervical corpectomy using an intra-operative computerized tomography scan (O-Arm system)

Fracture and contralateral dislocation of the twin facet joints of the lower cervical spine

The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the “surgical and research” articles in the European Spine Journal, 2011