Abstract
The purpose of this study was to undertake a critical review of the potential role of magnetic resonance imaging (MRI) in the evaluation of low back pain (LBP) and to determine if there were differences in the MRI appearances between various occupational groups. The study group, 149 working men (78 aged 20-30 years and 71 aged 31–58 years) from five different occupations (car production workers, ambulance men, office staff, hospital porters and brewery draymen), underwent MRI of the lumbar spine. Thirty-four percent of the subjects had never experienced LBP Twelve months later, the examination was repeated on 89 men. Age-related differences were seen in the MRI appearances of the lumbar spine. Disc degeneration was most common at L5/S 1 and was significantly more prevalent (P < 0.01) in the older age group (52%) than in the younger age group (27%). Although LBP was more prevalent in the older subjects there was no relationship between LBP and disc degeneration. No differences in the MRI appearance of the lumbar spine were observed between the five occupational groups. Overall, 45% had ‘abnormal’ lumbar spines (evidence of disc degeneration, disc bulging or protrusion, facet hypertrophy, or nerve root compression). There was not a clear relationship between the MRI appearance of the lumbar spine and LBP. Thirty-two percent of asymptomatic subjects had ‘abnormal’ lumbar spines and 47% of all the subjects who had experienced LBP had ‘normal’ lumbar spines. During the 12-month follow-up period, 13 subjects experienced LBP for the first time. However, there was no change in the MRI appearances of their lumbar spines that could account for the onset of LBP. Although MRI is an excellent technique for evaluating the lumbar spine, this study shows that it does not provide a suitable pre-employment screening technique capable of identifying those at risk of LBP.
Similar content being viewed by others
References
Altman DG (1991) Practical statistics for medical research. Chapman and Hall, London, p 404
Battie MC, Videman T, Gibbons LE, Fisher LD, Manninen H, Gill K (1995) Determinants of lumbar disc degeneration. Spine 20:2601–2612
Amonoo-Kuofi HS (1983) The density of muscle spindles in the medial, intermediate and lateral columns of human intrinsic postvertebral muscles. J Anat 136:509–519
Biering-Sorensen F, Rolsted Hansen F, Schroll M, Runeborg O (1985) The relation of spinal X-ray to low back pain and physical activity among 60-year old men and women. Spine 10:445–451
Blaser SI, Berns DH, Ross JS, Modic MT (1988) Disks, degeneration and MRI. MRI Decis 2:18–26
Boden SD, Davies DO, Dina TS, Patronas NJ, Wiesel SW (1990) Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects. J Bone Joint Surg Am 72:403–408
Brown MD (1975) Diagnosis of pain syndromes of the spine. Spine 6:233–248
Butler D, Trafimow JH, Anderssen GBJ, McNeill T, Huckman M (1990) Discs degenerate before facets. Spine 15:111–113
Cust G, Pearson JCG, Mair A (1972) The prevalence of low back pain in nurses. Int Nurs Rev 19:169–179
DeCandido P, Reinig JN, Dwyer AJ, Thompson KJ, Ducker TB (1988) Magnetic resonance assessment of the distribution of lumbar spine disease. J Spinal Disord 1:9–15
Dillane JB, Fry J, Kalton G (1966) Acute back syndrome - a study from British practice. BMJ 2:82
Evans W, Jobe W, Seibert C (1989) A cross-sectional prevalence study of lumbar disc degeneration in a working population. Spine 14:60–64
Gibson ES (1988) The value of preplacement screening radiography of the low back. In: Deyo R (ed) Back pain in workers. Hanley and Belfus, Philadelphia, pp 91–108
Gibson ES, Martin RH, Terry C (1980) Incidence of low back pain and preplacement X-ray screening. J Occup Med 22:515
Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS (1994) Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 331:69–73
Lipson SJ, Mair H (1981) Experimental intervertebral disc degeneration. Arthritis Rheum 24:12–21
Masaryk TJ, Ross JS, Modic MT (1988) High resolution of sequestrated lumbar intervertebral discs. Am J Radiol 150:1155–1161
Modic MT, Pavlicek W, Weinstein MA, Boumphrey F, Ngo F, Hardy R, Ducheseneau PM (1984) Magnetic resonance imaging of intervertebral disk disease. Radiology 152:103–111
Murphy RW (1977) Nerve roots and spinal nerves in degenerative disc disease. Clin Orthop 129:46–60
Naylor A, Happey F, Turner RL, Shentall RD, West DC, Richardson C (1975) Enzymic and immunological activity in the intervertebral disc. Orthop Clin North Am 6:51–58
Paajanen H, Erkintalo M, Kuusela T, Dahlstrom S, Kormano M (1989) Magnetic resonance study of disc degeneration in young low-back pain patients. Spine 14:982–985
Rab G, Chao E, Stauffer R (1977) Muscle force analysis of the lumbar spine. Orthop Clin North Am 8:195–199
Reid JG, Costigan PA (1985) Geometry of adult rectus abdominis and erector spinae muscles. J Soc Physiother 6:278–280
Riihimaki H, Mattson T, Zitting A, Wickstrom G, Hanninen K, Waris P (1990) Radiographically detectable degenerative changes of the lumbar spine among concrete reinforcement workers and house painters. Spine 15:114–119
Rowe ML (1969) Low back pain in industry. J Occup Med 11:161–169
Rowe ML (1982) Are routine spine films on workers in industry cost- or risk-benefit effective? J Occup Med 24:41–44
Sairanen E, Brushaber L, Kaskinen M (1981) Fell working, low back pain and osteoarthritis. Scand J Work Environ Health 7:18–30
Sandover J (1983) Dynamic loading as a possible source of low-back disorders. Spine 8:652–658
Savage R, Millerchip R, Whitehouse GH, Edwards RHT (1991) Lumbar muscularity and its relationship with age, occupation and low back pain. Eur J Appl Physiol 63:265–268
Schultz AB, Anderssen GBJ (1981) Analysis of loads on the lumbar spine. Spine 6:76–82
Svensson HO (1982) Low back pain in 40-47 year old men. II. socioeconomic factors and previous sickness absence. Scand J Rehab Med 14:55–60
Vernon-Roberts B, Pirie CJ (1977) Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae. Rheumatol Rehab 16:13–21]
Wilder DG, Pope MA, Frymoyer JW (1988) The biomechanics of lumbar disc herniation and the effect of overload and instability. J Spinal Disord 1:16–32
Wood CHW, Bailley EM (1980) Epidemiology of back pain. Pitman Medical, Tunbridge Wells
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Savage, R.A., Whitehouse, G.H. & Roberts, N. The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males. Eur Spine J 6, 106–114 (1997). https://doi.org/10.1007/BF01358742
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01358742