Relationship Between MRI Changes of The Lumbar Spine and Low Back Pain: A MRI Study of 1043 Population-Based Subjects

Abstract

Introduction. Previous small scale, non-population based studies have demonstrated that asymptomatic subjects can have a high incidence of MRI changes. To date, no direct relationship could be identified between low back pain and MRI changes. As part of a large scale genetic study, we have recruited a large number of volunteers for MRI scans of the lumbar spine. Subsequent microsatellite marker analysis confirmed that the sample was representative of the local population. This study aims to examine the relationship between MRI changes and low back pain. Method. Volunteers between the ages of 18 and 55 were invited for MRI scanning of the lumbar spine. A detailed pain history was taken from each subject including assessment by Oswestry Disability Index (ODI), Roland Morris score (RM), visual analogue scale (VAS) and SF36. All the scans were read by 2 experienced physicians blinded to the study information. Severity of degeneration at each level was graded using the Schneiderman’s classification, and the score for each disc was summated to give a total “DDD” score for the lumbar spine. Correlation between MRI changes and symptoms were attempted. Results. Overall 1043 subjects were recruited, of which 525 had at least one episode of LBP, but only 177 were currently in pain. An increase in the DDD score on MRI was directly related to an increase in the proportion of subjects with LBP, their ODI and VAS, but not their RM or SF36 scores. Discussion. This is the first large scale population study that demonstrates a relationship between the occurrence of LBP and MRI findings of degenerative disc disease. This relationship is revealed by some but not all measured pain parameters, the reason for this is the subject of further analysis. This study lends support to current biological research aiming to stop or reverse disc degeneration.