Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Back Pain”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 991 records · Page 55Linked to original sources
PubMed2001

Evaluation of the role of facet joints in persistent low back pain in obesity: a controlled, prospective, comparative evaluation.

Chronic low back pain and obesity are two common medical conditions. Obesity has been associated with symptoms such as adverse fat distribution and multiple secondary disorders, including low back pain. Obesity is defined as being 30% over ideal weight, which influences normal body mechanics as well as recovery from an injury. Facet joints have been described as contributing to a significant proportion of patients suffering with persistent or chronic low back pain, variably from 15% to 45%. Since an obese patient is at a higher risk of disability compared to a patient with normal weight, obesity has been described as a confounding factor in persistent low back pain. This study included 100 patients, with 50 patients in Group I who were of normal weight and 50 patients in group II who were obese, by random allocation. Facet joints were investigated with diagnostic blocks using lidocaine 1% initially, followed by bupivacaine 0.25%. The results showed that the prevalence rate of facet joint pain in chronic low back pain in Group I or nonobese patients was 36%, in contrast to 40% in Group II, or the obese patient group, with no significant differences among the two groups. The study also showed a false-positive rate of 39% in the total sample, or 44% in Group I nonobese patients and 33% in Group II, or obese patients. It is concluded that the prevalence of lumbar facet joint mediated pain of 40% in obese patients and 36% in patients of normal weight with a false-positive rate of 33% in obese patients and 44% in nonobese patients is similar to the results of multiple previous studies concluding that facet joint mediated pain is a common occurrence in obese patients; however, the incidence of facet joint mediated pain is similar in obese patients and nonobese patients.

Journal Article↗
PubMed1995

Back pain and parenthood.

OBJECTIVE: To test the hypothesis that reports of back pain in a working population are associated with parenthood. METHODS: A questionnaire survey of back pain in municipal fire fighters and police officers in a municipality in Ontario, Canada. The questionnaire was distributed to current employees of fire and police departments. The survey was completed by 129 fire fighters (68% of the active force) and 346 police officers (74% of the force). RESULTS: 36% of the respondents complained of a back problem. The prevalence increased from 13% among men aged 19 to 28 to 47% among men aged 49 to 59. The complaint was more common among firefighters (42%) than among police officers (33%). In a logistic regression analysis, back problems were significantly associated with the duration of employment, cigarette smoking, and the number of children. CONCLUSIONS: Back pain is a multifactorial problem with significant impact on the working population. This survey has found that parenthood, a risk factor not previously described among men, is associated with self reported back pain. The mechanism presumably involves lifting of children or recreational factors. Fatherhood seems to be a confounder that should be controlled for in studies of occupational causes of back pain.

Adult↗
PubMed1998

Back and hip extensor fatigability in chronic low back pain patients and controls.

OBJECTIVE: To compare the lumbar paraspinal and gluteus maximus muscle fatigability between chronic low back pain patients and healthy controls by using electromyographic (EMG) spectral analysis during a maximal isometric endurance task. DESIGN: A cross-sectional comparative study between chronic low back pain patients and healthy control subjects. SETTING: Physical medicine and rehabilitation clinic in Finland. SUBJECTS: Twenty women with nonspecific chronic low back pain (longer than 3 months) and 15 healthy controls. INTERVENTION: Subjects performed maximal voluntary isometric back extensions (MVC) at 30 degrees forward flexion in a specially designed measurement unit. A 50% MVC load was used in isometric endurance test. OUTCOME MEASURES: Low back pain intensity was assessed by using the visual analogue scale and functional disability by the Oswestry disability index. Time to endurance was measured. Bipolar surface EMG recordings were made over the lumbar paraspinal muscles (L3-L4, L5-S1) and over the gluteus maximus muscles. Average EMG (aEMG%), and initial spectral median frequency (MFinit) and change over time (MFslope) were computed. RESULTS: Pain intensity and functional disability were higher and MVC and time to endurance were lower in the chronic low back pain group (p < .05). Similar muscle activity levels (aEMG%) and MFinit indicated similar muscle loading in both groups at the beginning of the endurance test. EMG spectral decreases (MFslope) indicated that lumbar paraspinal muscle fatigability was similar in both groups. In the chronic low back pain group, the gluteus maximus fatigued faster than in the control group (greater MFslope, p < .05). However, the shorter endurance time indicated greater fatigability in the chronic low back pain group in general (p < .05). CONCLUSIONS: The chronic low back pain patients were weaker and fatigued faster than the healthy controls. The EMG fatigue analysis results suggest that the gluteus maximus muscles are more fatigable in chronic low back pain patients than in healthy control subjects during a sustained back extension endurance test.

Adult↗
PubMed1999

Lumbosacral transitional vertebrae and low back pain.

The correlation between lumbosacral transitional vertebrae and low back pain was analyzed in a study of plain radiographs from normal subjects and patients with chronic low back pain. Of 184 normal subjects, only 29 (15.8%) had transitional vertebrae, while 97 (35.1%) of 276 patients were noted to have transitional vertebrae. The difference was highly significant (p < 0.01). The incidence of Castellvi type II transitional vertebrae was significantly higher in patients with low back pain than in controls (p < 0.01). This study indicates the etiologic significance of lumbosacral transitional vertebra in low back pain.

Adult↗
PubMed2006

Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity.

Although obesity and physical activity have been argued to predict back pain, these factors are also related to incontinence and breathing difficulties. Breathing and continence mechanisms may interfere with the physiology of spinal control, and may provide a link to back pain. The aim of this study was to establish the association between back pain and disorders of continence and respiration in women. We conducted a cross-sectional analysis of self-report, postal survey data from the Australian Longitudinal Study on Women's Health. We used multinomial logistic regression to model four levels of back pain in relation to both the traditional risk factors of body mass index and activity level, and the potential risk factors of incontinence, breathing difficulties, and allergy. A total of 38,050 women were included from three age-cohorts. When incontinence and breathing difficulties were considered, obesity and physical activity were not consistently associated with back pain. In contrast, odds ratios (OR) for often having back pain were higher for women often having incontinence compared to women without incontinence (OR were 2.5, 2.3 and 2.3 for young, mid-age and older women, respectively). Similarly, mid-aged and older women had higher odds of having back pain often when they experienced breathing difficulties often compared to women with no breathing problems (OR of 2.0 and 1.9, respectively). Unlike obesity and physical activity, disorders of continence and respiration were strongly related to frequent back pain. This relationship may be explained by physiological limitations of co-ordination of postural, respiratory and continence functions of trunk muscles.

Adult↗
PubMed2002

Developing patient-centred information for back pain sufferers.

OBJECTIVE: To identify information needs among a group of back pain sufferers as well as the barriers that may prevent them from accessing this information. DESIGN: Data were collected through the use of open, in-depth interviews, through contributions to the Norwegian Back Pain Association's online discussion list, and through a search of the literature. PARTICIPANTS: Norwegian back pain sufferers and their carers. MAIN VARIABLES STUDIED: Information needs and barriers. RESULTS: The informants described information needs that covered a wide range of topics, clinical, financial, emotional and social. Informants wanted to understand the cause of their pain and wanted information about existing diagnoses and diagnostic procedures. Informants asked for information about treatment alternatives, both within and outside the established health-care system, the effects of these treatment alternatives, their procedures, side-effects and costs. In addition, informants wanted information about the social and emotional effects of long-term pain; coping with everyday life; other people's experiences; and about welfare benefits and patient rights. Barriers to this information included the use of medical, legal and other jargon, doctors' lack of time, lack of communication skills, lack of knowledge about back pain and attitudes to back pain patients. CONCLUSIONS: To successfully address the questions and concerns of users, there should be an attempt to present information on as many of these topics as possible. Information should be presented in the user's own language, at several levels of understanding, and should include both evidence- and experienced-based knowledge.

Adaptation, Psychological↗
PubMed2006

Association between back pain and physical fitness in adolescents.

STUDY DESIGN: A cross-sectional study of 9413 adolescents. OBJECTIVES: To study the associations between back pain, physical activity, and physical fitness. SUMMARY OF BACKGROUND DATA: A high physical fitness level, and especially muscle endurance in the back muscles, is associated with lower risk of back pain, but little is known about other types of physical fitness and back pain in adolescents. METHODS: A cross-sectional study of 3956 boys and 5457 girls 17 years of age. The associations between self-reported back pain and different types of physical fitness and self-reported physical activity were analyzed in high schoolchildren in Denmark. RESULTS: Back pain was reported by 43% of the girls and 37% of the boys. Back pain was associated with low isometric muscle endurance in the back extensors, and the highest quartile had a lower risk of back pain (odds ratio = 0.71; 95% confidence interval, 0.62-0.82) within the last month. No associations were found to aerobic fitness, functional strength, flexibility, or physical activity level after adjustment for muscle endurance. More girls than boys experienced back pain, and it was more common in taller adolescents. CONCLUSION: Children with high isometric muscle endurance were less likely to report back pain. No other measures of physical fitness or level of self-reported physical activity were linked to back pain reporting.

Adolescent↗
PubMed2006

Relationship between impaired functional stability and back pain in children: an exploratory cross-sectional study.

QUESTIONS UNDER STUDY: On surveys, about every fifth child in the school age reports back pain. There is a dearth of literature on the association between functional stability and back pain in children. OBJECTIVE: To examine the association between functional stability, measured with the Matthiasstest, and "back pain during the last week". METHODS: We used data from a cross-sectional survey on third, fourth and fifth grade school-years (128 children aged between 8 and 12 years) in seven different classes in two different rural regions of Switzerland, to evaluate in an explorative manner the association between the score of the Matthiass-test and low back pain and upper back pain in the last week with two multivariable logistic regressions. RESULTS: The Matthiass-test score, controlled for age, sex and language region of the school, was significantly associated with low back pain in the last week (adjusted odds ratio 1.77 with an 95% confidence interval from 1.08 to 2.91) and non significantly with the upper back pain in the last week (adjusted odds ratio 1.67 with an 95% confidence interval from 0.98 to 2.81). CONCLUSION: The Matthiass-test score is associated with low back pain. Because of the exploratory character of this study, these results should be regarded with caution. Whether a high score on the Matthiass-test could be a risk factor for back pain should be evaluated in prospective studies.

Back Pain↗
PubMed2004

Low back pain in a representative sample of Greek population: analysis according to personal and socioeconomic characteristics.

STUDY DESIGN: A cross-sectional study of low back pain and its related aspects in a representative sample of Greek population. OBJECTIVES: To estimate the prevalence of low back pain in the Greek population and to study the association of low back pain frequency and severity with socioeconomic and demographic characteristics. SUMMARY OF BACKGROUND DATA: Several prevalence studies carried out in different populations suggest a high frequency of this condition in the general population. Socioeconomic and demographic factors are likely to influence frequency and severity of low back pain. In Greece, there have been no previous studies investigating low back pain frequency and severity and its related aspects in the general population. Studies carried out in selected Greek populations suggest a 3-month prevalence of about 50%. METHODS: A 2000-person sample of the Greek population older than 15 years was selected by multiple-stage sampling, with definition of sample quotas based on demographic characteristics. Information about low back pain and its related aspects, as well as about socioeconomic and demographic characteristics, was collected by personal interviews. The study was carried out between March 10 and April 12, 2000. RESULTS: A total of 635 persons (31.7%) reported low back pain the last month. Among them 126 (19.9%) stayed in bed for some time, with a mean duration of staying in bed of 5.5 days. Work absenteeism represented a 19.1% of people younger than 65 years (54 persons) with a mean duration of 4.52 days. Low back pain frequency and severity were related to several socio-demographic factors at a statistically significant level. Sex, age, and kind of job presented a significant association with risk of low back pain independently from other socioeconomic factors. CONCLUSIONS: According to the results of the study, low back pain is a frequent symptom in the general Greek population. Low back pain frequency and severity are associated with several socio-demographic factors, especially with age, sex, and kind of job.

Absenteeism↗
PubMed2003

Safety and efficacy of percutaneous neuromodulation therapy in the management of subacute radiating low back pain.

OBJECTIVE: Percutaneous neuromodulation therapy (PNT) is a new minimally invasive, office-based treatment for low back pain in which electrical stimulation is delivered to the paraspinal peripheral nerves. The purpose of this study was to determine the safety, tolerability, and clinical efficacy of PNT in a population of patients with subacute low back pain with radiation to the lower extremity. DESIGN: Open label prospective clinical trial. SETTING: Multi-center outpatient setting. PARTICIPANTS: We enrolled 83 patients who had radiating low back pain for 4 weeks to 6 months with a pain intensity of at least 4 on a visual analog scale of 0-10. INTERVENTIONS: Subjects were treated with PNT 1 to 2 times per week for at least 4 weeks. Based on clinical response patients were treated up to an additional 8 weeks. MAIN OUTCOME MEASURES: We recorded baseline visual analog scale (VAS) scores of radiating pain, low back pain, physical activity, and sleep, as well as the Oswestry Disability Questionnaire. Follow-up assessments were performed at each session, and at 5 and 12 weeks. Patients benefiting from treatments at 12 weeks were followed-up at 6 months. RESULTS: Fifty-nine patients completed the study protocol. Mean VAS scores improved as follows: leg/buttock pain decreased by 37% to 4.0 +/- 2.6 from a baseline of 6.6 +/- 1.7 (P < 0.001); low back pain decreased by 26% to 3.9 +/- 2.4 from a baseline of 5.5 +/- 2.2 (P < 0.001); activity levels improved by 38% to 3.6 +/- 2.2 from a baseline of 6.0 +/- 2.2 (P < 0.001); and sleep improved by 27% to 3.1 +/- 2.5 from a baseline of 4.8 +/- 3.0 (P < 0.001). The Oswestry Low Back Pain Disability scores improved by 24% to 32 +/- 16 from a baseline of 43 +/- 15 (P < 0.001). Pain relief was sustained over a 3-month observation period. CONCLUSION: For many patients with subacute radiating low back pain, PNT significantly reduced pain and self-rated disability, and improved sleep quality and activity level. PNT is safe and generally well tolerated.

Journal Article↗
PubMed1999

Childhood leukemia presenting with back pain and vertebral compression fractures.

Vertebral body collapse and back pain are an unusual presentation for childhood leukemia. This report is intended to promote greater awareness that acute lymphocytic leukemia can cause significant back pain in children without other systemic symptoms. We describe four cases in which patients with acute lymphocytic leukemia presented with back pain and vertebral compression fractures. All of the patients were initially misdiagnosed. No patient had neurologic compromise, despite extensive vertebral body collapse. The back pain was relieved after chemotherapy.

Back Pain↗
PubMed2006

Repeated measures of recent headache, neck and upper back pain in Australian adolescents.

The epidemiological and clinical literature identifies strong associations between adult headache, cervical and thoracic spine dysfunction and spinal posture. This paper reports on the prevalence and incidence of headache, neck and upper back pain which occurred in the previous week, in urban Australians aged 13-17 years. Commencing in 1999, we followed a cohort of South Australian students through 5 years of secondary schooling. Of our commencing cohort of students, 132 (30%) provided data on bodily pain every year. For both girls and boys, there was a significantly decreasing prevalence of headache over the study period, while neck pain and upper back pain increased. There was a significantly increasing trend over time for boys with upper back pain. Twenty percent of girls and boys consistently reported headache, neck pain or upper back pain over 5 years. The progression of early adolescent headaches to mid-adolescent neck and upper back pain potentially reflects the adolescents' biomechanical responses to intrinsic and extrinsic imposts. This requires further investigation to understand the causes of adolescent headache, neck and upper thoracic pain.

Adolescent↗
PubMed1994

[Chemonucleolysis of disk herniation with low back pain as the single symptom: 20 cases].

Disk herniation can manifest as isolated low back pain, which is usually intermittent and accompanied with stiffness of the lumbar spine. There is almost general agreement that neither neurosurgical treatment nor chemonucleolysis is appropriate in patients with this clinical pattern. We used chemonucleolysis in 19 patients with recurrent episodes of isolated low back pain and one patient with severe permanent isolated low back pain dating back to a conservatively-treated episode of sciatica. All 20 patients had disk herniation documented by imaging studies. A very good or satisfactory outcome was recorded in ten patients after three months, 11 after six months and 12 in March 1993 after a mean follow-up of 72 months. The treatment was well tolerated, even in those patients who were not improved; a single patient developed an episode of acute low back pain that required surgical treatment. In patients with low back pain and disk herniation, there is currently no means of determining whether a causal relationship links these two abnormalities. Nevertheless, we believe that chemonucleolysis can be proposed in severe forms, provided the patients are apprised of current success rates.

Adult↗
PubMed1981

Delayed onset of epidural anesthesia in patients with back pain.

Onset and completeness of anesthesia were compared in 15 patients with back pain or sciatica and in 10 patients without back pain given lumbar epidural anesthesia with 20 to 25 ml of 1.5% mepivacaine, 80 mg of methylprednisolone, and 1:200,000 epinephrine. Sensory block was complete within 30 minutes in patients without back pain. Eleven of 15 (73%) patients with back pain had delayed onset of anesthesia ranging from 35 to 95 minutes. The difference between the two groups was statistically significant (p less than 0.001). When there was a delay, the affected nerve roots were blocked 10 to 70 minutes after the contralateral unaffected roots. Differences in time of onset between affected nerves and contralateral nerves were also significant (p less than 0.01). The nerve roots involved, as determined from the myelogram or the electromyogram, or those adjacent to them, were the roots with delayed onset of block. Any effect of the steroid on nerve blockade was ruled out as there was solid anesthesia in patients without back pain.

Adult↗
PubMed2004

Force production parameters in patients with low back pain and healthy control study participants.

STUDY DESIGN: A control group study with repeated measures. OBJECTIVE: To compare isometric force production parameters in low back pain and healthy study participants. SUMMARY AND BACKGROUND DATA: Recent evidence suggests that chronic patients with low back pain exhibit deficits in trunk proprioception and motor control. The control of force and its between-trial variability are often taken as critical determinants of performance. We compared various force time characteristics in patients with low back pain and healthy study participants. METHODS: Fifteen control study participants and 16 patients with low back pain participated in this study. Study participants were required to exert 50% and 75% of the maximal trunk flexion and extension. In a learning phase, visual and verbal feedback was provided. Following these learning trials, study participants were asked to perform 10 trials without any feedback. Time to peak force, time to peak force variability, peak force variability, and absolute error in peak force were calculated. Time to peak and peak dF/dt were computed to determine if the first peak of dF/dt could predict the peak force achieved. RESULTS: Two subgroups of patients with low back pain were identified. Controls and patients with low back pain with more pain showed faster time to peak force than patients with low back pain with less pain (331 ms and 341 ms vs. 574 ms, respectively). Linear regressions showed that, for control study participants and low back pain study participants with more pain, peak dF/dt explained 94.0% and 97.0% of the variance observed in peak force while 84.4% was explained for low back pain study participants with less pain. Peak force variability and absolute error in peak force were similar for all groups. CONCLUSIONS: Patients with low back pain were able to produce isometric forces with an accuracy similar to control study participants. The longer time to peak force and the smaller percentage of variance observed for the linear regressions suggest that some patients with low back pain adopted a control mode that was less "open-loop." It is possible that this mode of producing forces results from an adaptation to chronic pain or tissue degeneration.

Adult↗
PubMed2005

Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain.

OBJECTIVES: To test whether patients with persistent non-specific low back pain, when offered access to traditional acupuncture care alongside conventional primary care, gained more long-term relief from pain than those offered conventional care only, for equal or less cost. Safety and acceptability of acupuncture care to patients, and the heterogeneity of outcomes were also tested. DESIGN: A pragmatic, two parallel group, randomised controlled trial. Patients in the experimental arm were offered the option of referral to the acupuncture service comprising six acupuncturists. The control group received usual care from their general practitioner (GP). Eligible patients were randomised in a ratio of 2:1 to the offer of acupuncture to allow between-acupuncturist effects to be tested. SETTING: Three non-NHS acupuncture clinics, with referrals from 39 GPs working in 16 practices in York, UK. PARTICIPANTS: Patients aged 18-65 years with non-specific low back pain of 4-52 weeks' duration, assessed as suitable for primary care management by their general practitioner. INTERVENTIONS: The trial protocol allowed up to ten individualised acupuncture treatments per patient. The acupuncturist determined the content and the number of treatments according to patient need. MAIN OUTCOME MEASURES: The Short Form 36 (SF-36) Bodily Pain dimension (range 0-100 points), assessed at baseline, and 3, 12 and 24 months. The study was powered to detect a 10-point difference between groups at 12 months post-randomisation. Cost--utility analysis was conducted at 24 months using the EuroQoL 5 Dimensions (EQ-5D) and a preference-based single index measure derived from the SF-36 (SF-6D). Secondary outcomes included the McGill Present Pain Index (PPI), Oswestry Pain Disability Index (ODI), all other SF-36 dimensions, medication use, pain-free months in the past year, worry about back pain, satisfaction with care received, and safety and acceptability of acupuncture care. RESULTS: A total of 159 patients were in the 'acupuncture offer' arm and 80 in the 'usual care' arm. All 159 patients randomised to the offer of acupuncture care chose to receive acupuncture treatment, and received an average of eight acupuncture treatments within the trial. Analysis of covariance, adjusting for baseline score, found an intervention effect of 5.6 points on the SF-36 Pain dimension [95% confidence interval (CI) -1.3 to 12.5] in favour of the acupuncture group at 12 months, and 8 points (95% CI 0.7 to 15.3) at 24 months. No evidence of heterogeneity of effect was found for the different acupuncturists. Patients receiving acupuncture care did not report any serious or life-threatening events. No significant treatment effect was found for any of the SF-36 dimensions other than Pain, or for the PPI or the ODI. Patients receiving acupuncture care reported a significantly greater reduction in worry about their back pain at 12 and 24 months compared with the usual care group. At 24 months, the acupuncture care group was significantly more likely to report 12 months pain free and less likely to report the use of medication for pain relief. The acupuncture service was found to be cost-effective at 24 months; the estimated cost per quality-adjusted (QALY) was 4241 pounds sterling (95% CI 191 pounds sterling to 28,026 pounds sterling) using the SF-6D scoring algorithm based on responses to the SF-36, and 3598 pounds sterling (95% CI 189 pounds sterling to 22,035 pounds sterling) using the EQ-5D health status instrument. The NHS costs were greater in the acupuncture care group than in the usual care group. However, the additional resource use was less than the costs of the acupuncture treatment itself, suggesting that some usual care resource use was offset. CONCLUSIONS: Traditional acupuncture care delivered in a primary care setting was safe and acceptable to patients with non-specific low back pain. Acupuncture care and usual care were both associated with clinically significant improvement at 12- and 24-month follow-up. Acupuncture care was significantly more effective in reducing bodily pain than usual care at 24-month follow-up. No benefits relating to function or disability were identified. GP referral to a service providing traditional acupuncture care offers a cost-effective intervention for reducing low back pain over a 2-year period. Further research is needed to examine many aspects of this treatment including its impact compared with other possible short-term packages of care (such as massage, chiropractic or physiotherapy), various aspects of cost-effectiveness, value to patients and implementation protocols.

Acupuncture Therapy↗
PubMed2001

Extending the Aberdeen Back Pain Scale to include the whole spine: a set of outcome measures for the neck, upper and lower back.

Many therapists treat the spine as a 'functional unit', but suitable condition-specific outcome measures for the whole spine are not available. One of the most rigorously tested measures for back pain related health status is the Aberdeen Back Pain Scale, but it is only suitable for the lower back. The Aberdeen Back Pain Scale was extended to create a set of interlocking outcome measures for the neck, upper and lower back. Questions in these extended outcome measures had to fulfil a series of psychometric criteria before being accepted into the final questionnaires. This involved response frequency, item-total correlation and principal component analysis. The final questionnaires were tested for reliability, criterion and construct validity, responsiveness and acceptability, on patients attending a primary care musculoskeletal clinic. One question was discarded from all three sets of questionnaires and a further question was removed from the neck questionnaire. Baseline scores approximated to normal distributions. Although not completely reproducible, they were internally consistent, so showed evidence of reliability. They were highly correlated with the SF-12 and their mean scores changed according to whether their health status, measured by a transition question, improved, stayed the same or worsened. Modified standardised response means showed large changes when health status improved and moderate-sized changes when health status worsened. Patients made few adverse comments about the questionnaires and found them acceptable. The Extended Aberdeen Spine Pain Scales for neck, upper and lower back pain, showed evidence of reliability, validity, responsiveness and acceptability. They can be used for single regions of the spine or combined as clinically necessary. They are particularly recommended for primary care patients.

Adult↗
PubMed1994

Magnetic resonance imaging of the lumbar spine in people without back pain.

BACKGROUND: The relation between abnormalities in the lumbar spine and low back pain is controversial. We examined the prevalence of abnormal findings on magnetic resonance imaging (MRI) scans of the lumbar spine in people without back pain. METHODS: We performed MRI examinations on 98 asymptomatic people. The scans were read independently by two neuroradiologists who did not know the clinical status of the subjects. To reduce the possibility of bias in interpreting the studies, abnormal MRI scans from 27 people with back pain were mixed randomly with the scans from the asymptomatic people. We used the following standardized terms to classify the five intervertebral disks in the lumbosacral spine: normal, bulge (circumferential symmetric extension of the disk beyond the interspace), protrusion (focal or asymmetric extension of the disk beyond the interspace), and extrusion (more extreme extension of the disk beyond the interspace). Nonintervertebral disk abnormalities, such as facet arthropathy, were also documented. RESULTS: Thirty-six percent of the 98 asymptomatic subjects had normal disks at all levels. With the results of the two readings averaged, 52 percent of the subjects had a bulge at at least one level, 27 percent had a protrusion, and 1 percent had an extrusion. Thirty-eight percent had an abnormality of more than one intervertebral disk. The prevalence of bulges, but not of protrusions, increased with age. The most common nonintervertebral disk abnormalities were Schmorl's nodes (herniation of the disk into the vertebral-body end plate), found in 19 percent of the subjects; annular defects (disruption of the outer fibrous ring of the disk), in 14 percent; and facet arthropathy (degenerative disease of the posterior articular processes of the vertebrae), in 8 percent. The findings were similar in men and women. CONCLUSIONS: On MRI examination of the lumbar spine, many people without back pain have disk bulges or protrusions but not extrusions. Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.

Adult↗