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MRI image features with an evident relation to low back pain: a narrative review

Whats the Relationship Between MRI Findings Clinical Symptoms in Patients with Suspected Lumbar Spinal Canal Stenosis

Low back pain (LBP) is a prevalent condition that affects millions of people worldwide and is a leading cause of disability. Magnetic resonance imaging (MRI) of the lumbar spine is commonly used to diagnose and assess LBP. However, there is ongoing debate regarding its appropriate use and interpretation. Understanding the relationship between specific MRI image features and LBP can help clinicians make informed decisions about treatment and management options.

What's the Relationship Between MRI Findings & Clinical Symptoms in Patients with Suspected Lumbar Spinal Canal Stenosis_

Review of MRI features

In a comprehensive review, various MRI image features related to LBP were evaluated across five categories: discogenic, neuropathic, osseous, facetogenic, and paraspinal. The review included large-scale studies with high-quality evidence, and provides a robust analysis of the relevant image features in relation to LBP.

Out of the 29 image features evaluated, 11 showed a positive association with LBP. These included features such as Modic changes, disc herniation, ligamentum flavum hypertrophy, and muscle fat infiltration. These findings suggest that these image features may play a role in the pathophysiology of LBP and could be potential targets for intervention and treatment.

This is the full list of MRI features with a positive association:

  • Modic changes in general [67%]
  • Modic changes type I [100%]
  • Disc narrowing [67%]
  • Endplate defects [67%]
  • Pfirrmann grade [67%]
  • Disc herniation [100%]
  • Disc extrusion [100%]
  • Ligamentum flavum hypertrophy [100%]
  • Central spinal canal stenosis [70%]
  • Nerve compression [100%]
  • Muscle fat infiltration [67%]

Two image features had mixed results, with an equivocal association with LBP. Spondylolisthesis and paraspinal muscle cross-sectional area showed variable findings across studies, indicating the need for further research to clarify their relationship with LBP.

Seven image features showed no association with LBP. These included Modic changes type II and type III, disc bulging, high intensity zone, disc protrusion, foramen stenosis, and facet fluid sign. These results indicate that these image features may not be directly related to the presence or severity of LBP.

Additionally, nine image features had inconclusive evidence, highlighting the need for more research to determine their association with LBP. Features such as black discs, synovial cysts, facet hypertrophy, osteomyelitis, and vertebral body infarction require further investigation to establish their significance in the context of LBP.


MRI image features and LBP

This review underscores the importance of conducting high-quality research to deepen our understanding of the relationship between MRI image features and LBP. The findings provide valuable insights into the positive, mixed, and no associations between specific image features and LBP. 

By gaining a better understanding of these associations, healthcare professionals can enhance their diagnostic accuracy, improve treatment decisions, and ultimately optimize patient outcomes, in a similar way our models do. Naturally, further research is needed to fill the gaps in knowledge. This research could also provide clinicians with evidence-based guidelines for the appropriate use and interpretation of MRI in the evaluation of LBP.

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