Skip to main content

Advertisement

SpringerLink
Log in

Relationship between low back pain, disability, MR imaging findings and health care provider

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine the association between the self-report of pain and disability and findings on lumbar MR images, and to compare two different health care providers in Spanish patients with low back pain (LBP).

Design

Cross-sectional

Material and methods

A total of 278 patients, 137 men and 141 women aged 44±14 years submitted with low back pain (LBP) were studied. One hundred and nine patients were from the National Health System (NHS) and 169 from private practice. Patients with previous discitis, surgery, neoplasm or traumatic episodes were excluded. Every patient completed a disability questionnaire with six core items, providing a score of disability from 2 to 28. All patients had sagittal spin-echo T1 and turbo spin-echo T2, axial proton-density and MR myelography weighted images. MR images of the two most affected disc levels were read, offering an MR imaging score from 0 to 30.

Results

Patients with a combination of LBP and sciatica showed the highest levels of disability (p=0.002). MR imaging scores only correlated with pain interference with normal work (p=0.04), but not with other disability questions. Patients from the NHS showed greater disability scores than private ones (p=0.001) and higher MR imaging scores (p=0.01).

Conclusion

In patients with LBP, MR imaging only correlates with pain interference with work but not with other disability questions. Differences are found between private and NHS patients, the latter being more physically affected.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Espeland A, Albrektsen G, Larsen JL. Plain radiography of the lumbosacral spine. An audit of referrals from general practitioners. Acta Radiol 1999;40:52–59

    CAS  PubMed  Google Scholar 

  2. Beattie PF, Meyers SP, Stratford P, Millard RW, Hollenberg GM. Associations between patient report of symptoms and anatomic impairment visible on lumbar magnetic resonance imaging. Spine 2000;25:819–828

    Article  CAS  Google Scholar 

  3. Hollingworth W, Dixon AK, Todd CJ, et al. Self reported health status and magnetic resonance imaging findings in patients with low back pain. Eur Spine J 1998;7:369–375

    Article  CAS  Google Scholar 

  4. MacGregor AJ, Andrew T, Sambrook PN, Spector TD. Structural, psychological, and genetic influences on low back and neck pain: a study of adult female twins. Arthritis Rheum 2004;51:160–167

    Article  Google Scholar 

  5. Videman T, Battié MC, Gibbons LE, Maravilla KR, Manninen H, Kaprio J. Associations between back pain history and lumbar MRI findings. Spine 2003;28:582–588

    PubMed  Google Scholar 

  6. Karppinen J, Malmivaara A, Tervonen O et al. Severity of symptoms and signs in relation to magnetic resonance imaging findings among sciatic patients. Spine 2001;26:E149–E154

    Article  CAS  Google Scholar 

  7. Jarvik JJ, Hollingworth W, Heagerty P, Haynor DR, Deyo RA. The longitudinal assessment of imaging and disability of the back (LAIDBack) study. Spine 2001;26:1158–1166

    Article  CAS  Google Scholar 

  8. Deyo RA, Battie M, Beurskens AJHM, et al. Outcome measures for low back pain research. A proposal for standardized use. Spine 1998;23:2003–2013

    Article  CAS  Google Scholar 

  9. Leino-Arjas P, Hänninen K, Puska P. Socioeconomic variation in back and joint pain in Finland. Eur J Epidemiol 1998;14:79–87

    Article  CAS  Google Scholar 

  10. van Lenthe FJ, Schrijvers CT, Droomers M, Joung IM, Louwman MJ, Mackenbach JP. Investigating explanations of socio-economic inequalities in health: the Dutch GLOBE study. Eur J Public Health 2004;14:63–70

    Article  Google Scholar 

  11. Rodríguez M. El espacio de los seguros privados en los sistemas sanitarios públicos: marco conceptual y políticas. Gac Sanit 2001;15:527–537

    Article  Google Scholar 

  12. Madan SS, Boeree NR. Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion. Eur Spine J 2003;12:567–575

    Article  CAS  Google Scholar 

  13. Brant-Zawadzki MN, Jensen MC, Obuchowski N, Ross JS, Modic MT. Interobserver and intraobserver variability in interpretation of lumbar disc abnormalities. Spine 1995;20:1257–1264

    Article  CAS  Google Scholar 

  14. Fardon DF, Milette PC. Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology and American Society of Neuroradiology. Spine 2001;26:E93–E113

    Article  CAS  Google Scholar 

  15. Takahashi K, Miyazaki T, Ohnari H, Takino T, Tomita K. Schmorl’s nodes and low-back pain. Analysis of magnetic resonance imaging findings in symptomatic and asymptomatic individuals. Eur Spine J 1995;4:56–59

    Article  CAS  Google Scholar 

  16. Jensen MC, Kelly AP, Brant-Zawadzki MN. MRI of degenerative disease of the lumbar spine. Magn Reson Q 1994;10:173–190

    CAS  PubMed  Google Scholar 

  17. Aprill C, Bogduk N. High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br J Radiol 1992;65:361–369

    Article  CAS  Google Scholar 

  18. Mounce K. Back pain. Rheumatology 2002;41:1–5

    Article  CAS  Google Scholar 

  19. Amundsen T, Weber H, Lilleas F, Nordal HJ, Abdelnoor M, Magnaes B. Lumbar spinal stenosis. Clinical and radiological features. Spine 1995;20:1178–1186

    Article  CAS  Google Scholar 

  20. Rantanen P. Physical measurements and questionnaires as diagnostic tools in chronic low back pain. J Rehab Med 2001;33:31–35

    Article  CAS  Google Scholar 

  21. Porchet F, Wietlisbach V, Burnand B, Daeppen K, Villemure JG, Vader JP. Relationship between severity of lumbar disc disease and disability scores in sciatica patients. Neurosurgery 2002;50:1253–1260

    PubMed  Google Scholar 

  22. Dionne CE, Von Korff M, Koepsell TD, et al. Formal education and back pain: a review. J Epidemiol Community Health 2001;55:455–468

    Article  CAS  Google Scholar 

  23. Leino-Arjas P, Kaila-Kangas L, Keskimäki I, Notkola V, Mutanen P. Impatient hospital care for lumbar intervertebral disc disorders in Finland in relation to education, occupational class, income, and employment. Public Health 2002;116:272–278

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  25. McNally EG, Wilson DJ, Ostlere SJ. Limited magnetic resonance imaging in low back pain instead of plain radiographs: experience with first 1000 cases. Clin Radiol 2001;56:922–925

    Article  CAS  Google Scholar 

  26. Zanoli G, Stromqvist B, Jonsson B, Padua R, Romanini E. Pain in low back-pain. Problems in measuring outcomes in musculoskeletal disorders. Acta Orthop Scand Suppl 2002;305:54–57

    Article  Google Scholar 

  27. Haig AJ, Weiner JB, Tew J, Quint J, Yamakawa K. The relation among spinal geometry on MRI, paraspinal electromyographic abnormalities, and age in persons refferred for electrodiagnostic testing of low back symptoms. Spine 2002;27:1918–1925

    Article  Google Scholar 

  28. Hagg O, Fritzell P, Nordwall A, Swedish Lumbar Spine Study Group. The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 2003;12:12–20

    CAS  PubMed  Google Scholar 

  29. Weishaupt D, Zanetti M, Hodler J et al. Painful lumbar disk derangement: Relevance of endplate abnormalities at MR imaging. Radiology 2001;218:420–427

    Article  CAS  Google Scholar 

  30. Mitra D, Cassar-Pullicino VN, McCall IW. Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine. Eur Radiol 2004;14:1574–1581

    Article  CAS  Google Scholar 

  31. Mackenzie R, Dixon AK. Measuring the effects of imaging: an evaluative framework. Clin Radiol 1995;50:513–518

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Clínica Quirón, Av. Blasco Ibañez, 14, 46010, Valencia, Spain

    Estanislao Arana, Luis Martí-Bonmatí, Enrique Mollá, Salvador Costa & Rubén Montijano

  2. Department of Radiology, Hospital Universitario Dr. Peset, Valencia, Spain

    Luis Martí-Bonmatí & María Vega

  3. Department of Preventive Medicine, Hospital Universitario Dr. Peset, Valencia, Spain

    Daniel Bautista

Authors
  1. Estanislao Arana
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luis Martí-Bonmatí
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. María Vega
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Bautista
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Enrique Mollá
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Salvador Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rubén Montijano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Estanislao Arana.

Appendices

Appendix 1

PATIENT STATUS (note: most of these items are included in the AAOS Lumbar cluster, the Low Back Pain Type, and the NASS low back Outcome instrument, according to Deyo et al. [8]. This is a Spanish version)

1. During the past week, how bothersome have each of the following symptoms been? (circle one number in each row)

a. Low back pain [0] [1] [2] [3] [4]

b. Leg pain (sciatica) [0] [1] [2] [3] [4]

2. During the past week, how much did pain interfere with your normal work (including both work outside the home and housework)?

[0] Not at all [1] A little bit [2] Moderately [3] Quite a bit [4] Extremely

3. If you had to spend the rest of your life with the symptoms you have right now, how would you feel about it?

[4] Very [3] Somewhat [2] Neither satisfied [1] Somewhat [0] Very

dissatisfied dissatisfied nor dissatisfied satisfied satisfied

4. During the past 4 weeks, about how many days did you cut down on the things you usually do for more than half the day because of back pain or leg pain (sciatica)? _______ Number of days (0–7 days= [1]; 8–15 days= [2]; 16–22 days= [3]; >/=23 days= [4])

5. During the past 4 weeks, about how many days did low back pain or leg pain (sciatica) keep you from going to work or school?_______ Number of days (0–7 days= [1]; 8–15 days= [2]; 16–22 days=[3]; >/= 23 days= [4])

6. Over the course of treatment for your low back pain or leg pain (sciatica), how satisfied were you with your overall medical care?

[4] Very [3] Somewhat [2] Neither satisfied [1] Somewhat [0] Very

dissatisfied dissatisfied nor dissatisfied satisfied satisfied

7. How many days have elapsed since your doctor solicited this test? _______ Number of days

Note: The numbers in brackets [ ] are the points. Minimum points are 0 and maximum are 28. Question 7 is not included in the score.

Appendix 2

MR imaging findings

Finding

Definition

Reference

Disc

[0] Normal [1] Dehydrated [2] Protrusion [3] Extrusion/sequestration or Schmorl’s node with Modic type 1

Fardon [14], Jensen [16] and Takahashi [15]

Annular tear

[0] No [3] Yes

Fardon [14] and Aprill [17]

Facet joint

[0] Mild: normal or mild hypertrophy with minimal or no neural foramen encroachment [2] Moderate: moderate hypertrophy with moderate neural foramen or canal encroachment [3] Severe: Extensive hypertrophy with severe neural foramen or canal encroachment

Jarvik [7]

Spinal Stenosis

[0] Mild: encroachment on central canal but abundant cerebrospinal fluid still present around roots[2] Moderate: crowded roots with only small amount of residual cerebrospinal fluid[3] Severe: no residual cerebrospinal fluid

Jarvik [7]

Other pathologies

[3] Degenerative spondylolisthesis, Bilateral spondylolysis, Neoplasm (other than haemangioma, enchondroma or bone island), Spondylodiscitis

None

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arana, E., Martí-Bonmatí, L., Vega, M. et al. Relationship between low back pain, disability, MR imaging findings and health care provider. Skeletal Radiol 35, 641–647 (2006). https://doi.org/10.1007/s00256-006-0100-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-006-0100-x

Keywords

Search

Navigation