Is there an association between the number of magnetic resonance imaging findings and low back pain?

Magnetic resonance imaging (MRI) findings aren't completely useless to predict low back pain. That patient with the long list of abnormalities is more likely to have back problems than the patient with just a single finding or a normal result. (LOE = 2b)

Hancock MJ, Kjaer P, Kent P, Jensen RK, Jensen TS. Is the number of different MRI findings more strongly associated with low back pain than single MRI findings? Spine 2017;42(17):1283-1288.  [PMID:28169955]

Cross-sectional

Other

Outpatient (any)

We know that the association between any single abnormality on an MRI and low back pain is weak at best. Some patients have a great deal of pain and no findings, or findings in the "wrong" place on their MRI, while others have abnormalities on MRI but no pain in that anatomic distribution. These researchers used 2 datasets to dig deeper into this question. The first cross-sectional dataset included 412 Danes who were asked about whether they had back pain in the past year (69% had), and who also underwent MRI of the lower back. The second was a group of 76 persons in Australia who recently recovered from an episode of low back pain, and who were followed up for 12 months to see if they had a recurrence (39% did). In the cross-sectional group, the likelihood of low back pain increased with an increasing number of findings: the adjusted odds ratio was 2.0 for 1 finding, 3.9 for 2 findings, and 14.6 for 3 to 4 findings. The same thing was true regarding recurrence, with adjusted odds ratios of 3.3, 8.6, and 24.0, respectively, for 1, 2, or 3 findings compared with no findings. In absolute terms, the rate of recurrence over 1 year was 11%, 29%, 52%, and 75% for patients with 0, 1, 2, or 3 MRI findings, respectively. Some findings were relatively nonpredictive, such as the presence of facet joint osteoarthritis. Spondylolisthesis and modic changes to bone, however, strongly predicted back pain in the previous year, and disc height loss and degenerative disc changes predicted recurrence.