Clinical presentation of low back pain and association with risk factors according to findings on magnetic resonance imaging
Clinical presentation of low back pain and association with risk factors according to findings on magnetic resonance imaging
We hypothesised that the relative importance of physical and psychological risk factors for mechanical low back pain (LBP) might differ importantly according to whether there is underlying spinal pathology, psychological risk factors being more common in patients without demonstrable pathology. If so, epidemiological studies of LBP could benefit from tighter case definitions. To test the hypothesis, we used data from an earlier case-control study on patients with mechanical LBP who had undergone magnetic resonance imaging (MRI) of the lumbosacral spine. MRI scans were classified for the presence of high-intensity zone (HIZ), disc degeneration, disc herniation, and nerve root displacement/compression. Information about symptoms and risk factors was elicited by postal questionnaire. Logistic regression was used to assess associations of MRI abnormalities with symptoms and risk factors, which were characterised by odds ratios (ORs) and 95% confidence intervals (CIs). Among 354 patients (52% response), 306 (86.4%) had at least 1, and 63 (17.8%) had all 4 of the MRI abnormalities. Radiation of pain below the knee (280 patients) and weakness or numbness below the knee (257 patients) were both associated with nerve root deviation/compression (OR 2.5, 95% CI 1.4 to 4.5; and OR 1.8, 95% CI 1.1 to 3.1, respectively). However, we found no evidence for the hypothesised differences in risk factors between patients with and without demonstrable spinal pathology. This suggests that when researching the causes and primary prevention of mechanical LBP, there may be little value in distinguishing between cases according to the presence or absence of the more common forms of potentially underlying spinal pathology. In patients with low back pain investigated by magnetic resonance imaging, absence of demonstrable spinal pathology was not associated differentially with psychological risk factors.
low back pain, mri, high-intensity zone, disc degeneration, disc prolapse, nerve root compression, symptoms, risk factors
Shambrook, James
2d8e6b6d-5354-421e-bcc0-c44aa0cb9565
McNee, Philip
96c406d9-5b9c-42e6-ba26-df34151e1402
Harris, E. Clare
3e4bd946-3f09-45a1-8725-d35e80dd7971
Kim, Miranda
c2e4ad50-0a64-4da9-8335-78531d88e93d
Sampson, Madeleine
e689ac99-ce4d-48d4-af7a-2a19cacb9d09
Palmer, Keith T.
0cfe63f0-1d33-40ff-ae8c-6c33601df850
Coggon, David
2b43ce0a-cc61-4d86-b15d-794208ffa5d3
22 April 2011
Shambrook, James
2d8e6b6d-5354-421e-bcc0-c44aa0cb9565
McNee, Philip
96c406d9-5b9c-42e6-ba26-df34151e1402
Harris, E. Clare
3e4bd946-3f09-45a1-8725-d35e80dd7971
Kim, Miranda
c2e4ad50-0a64-4da9-8335-78531d88e93d
Sampson, Madeleine
e689ac99-ce4d-48d4-af7a-2a19cacb9d09
Palmer, Keith T.
0cfe63f0-1d33-40ff-ae8c-6c33601df850
Coggon, David
2b43ce0a-cc61-4d86-b15d-794208ffa5d3
Shambrook, James, McNee, Philip, Harris, E. Clare, Kim, Miranda, Sampson, Madeleine, Palmer, Keith T. and Coggon, David
(2011)
Clinical presentation of low back pain and association with risk factors according to findings on magnetic resonance imaging.
Pain.
(doi:10.1016/j.pain.2011.03.011).
(PMID:21514999)
Abstract
We hypothesised that the relative importance of physical and psychological risk factors for mechanical low back pain (LBP) might differ importantly according to whether there is underlying spinal pathology, psychological risk factors being more common in patients without demonstrable pathology. If so, epidemiological studies of LBP could benefit from tighter case definitions. To test the hypothesis, we used data from an earlier case-control study on patients with mechanical LBP who had undergone magnetic resonance imaging (MRI) of the lumbosacral spine. MRI scans were classified for the presence of high-intensity zone (HIZ), disc degeneration, disc herniation, and nerve root displacement/compression. Information about symptoms and risk factors was elicited by postal questionnaire. Logistic regression was used to assess associations of MRI abnormalities with symptoms and risk factors, which were characterised by odds ratios (ORs) and 95% confidence intervals (CIs). Among 354 patients (52% response), 306 (86.4%) had at least 1, and 63 (17.8%) had all 4 of the MRI abnormalities. Radiation of pain below the knee (280 patients) and weakness or numbness below the knee (257 patients) were both associated with nerve root deviation/compression (OR 2.5, 95% CI 1.4 to 4.5; and OR 1.8, 95% CI 1.1 to 3.1, respectively). However, we found no evidence for the hypothesised differences in risk factors between patients with and without demonstrable spinal pathology. This suggests that when researching the causes and primary prevention of mechanical LBP, there may be little value in distinguishing between cases according to the presence or absence of the more common forms of potentially underlying spinal pathology. In patients with low back pain investigated by magnetic resonance imaging, absence of demonstrable spinal pathology was not associated differentially with psychological risk factors.
Text
Clinical_presentation_of_LBP_and_association_with_...(PAIN_March_2011).pdf
- Accepted Manuscript
Restricted to Repository staff only
Request a copy
More information
Published date: 22 April 2011
Keywords:
low back pain, mri, high-intensity zone, disc degeneration, disc prolapse, nerve root compression, symptoms, risk factors
Identifiers
Local EPrints ID: 188015
URI: http://eprints.soton.ac.uk/id/eprint/188015
ISSN: 0304-3959
PURE UUID: 002290af-905f-4d80-92a6-678a4e11b4c3
Catalogue record
Date deposited: 19 May 2011 14:05
Last modified: 15 Mar 2024 02:52
Export record
Altmetrics
Contributors
Author:
James Shambrook
Author:
Philip McNee
Author:
E. Clare Harris
Author:
Miranda Kim
Author:
Madeleine Sampson
Author:
Keith T. Palmer
Author:
David Coggon
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics