European Spine Journal

, Volume 21, Issue 2, pp 220–227 | Cite as

Magnetic resonance imaging for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica: a diagnostic systematic review

  • Merel WassenaarEmail author
  • Rogier M. van Rijn
  • Maurits W. van Tulder
  • Arianne P. Verhagen
  • Danielle A. W. M. van der Windt
  • Bart W. Koes
  • Michiel R. de Boer
  • Abida Z. Ginai
  • Raymond W. J. G. Ostelo
Review Article



In about 5% of all cases LBP is associated with serious underlying pathology requiring diagnostic confirmation and directed treatment. Magnetic resonance imaging (MRI) is often used for this diagnostic purpose yet its role remains controversial. Consequently, this review aimed to summarize the available evidence on the diagnostic accuracy of MRI for identifying lumbar spinal pathology in adult low back pain (LPB) or sciatica patients.


MEDLINE, EMBASE and CINAHL were searched (until December 2009) for observational studies assessing the diagnostic accuracy of MRI compared to a reference test for the identification of lumbar spinal pathology. Two reviewers independently selected studies for inclusion, extracted data and assessed methodological quality. Pooled summary estimates of sensitivity and specificity with 95% confidence intervals were calculated for homogenous subsets of studies.


Eight studies were included in this review. Strata were defined for separate pathologies i.e. lumbar disc herniation (HNP) and spinal stenosis. Five studies comparing MRI to findings at the surgery for identifying HNP were included in a meta-analysis. Pooled analysis resulted in a summary estimate of sensitivity of 75% (95% CI 65–83%) and specificity of 77% (95% CI 61–88%). For spinal stenosis pooling was not possible.


The results suggest that a considerable proportion of patients may be classified incorrectly by MRI for HNP and spinal stenosis. However, the evidence for the diagnostic accuracy of MRI found by this review is not conclusive, since the results could be distorted due to the limited number of studies and large heterogeneity.


Diagnostic accuracy Systematic review MRI Low back pain Diagnostic imaging 



Low back pain


Magnetic resonance imaging


Herniated nucleus pulposus



We thank Rene Otten for his useful help in designing the search strategy. This project was funded by Health Care Insurance Board (CvZ), Diemen, The Netherlands.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Merel Wassenaar
    • 1
    • 6
    Email author
  • Rogier M. van Rijn
    • 2
  • Maurits W. van Tulder
    • 1
    • 3
  • Arianne P. Verhagen
    • 2
  • Danielle A. W. M. van der Windt
    • 5
  • Bart W. Koes
    • 2
  • Michiel R. de Boer
    • 1
  • Abida Z. Ginai
    • 4
  • Raymond W. J. G. Ostelo
    • 1
    • 3
  1. 1.Department of Health Sciences, Faculty of Earth and Life SciencesVU University AmsterdamAmsterdamThe Netherlands
  2. 2.Department of General Practice, University Medical CenterErasmus MCRotterdamThe Netherlands
  3. 3.Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care ResearchVU University Medical Center AmsterdamAmsterdamThe Netherlands
  4. 4.Department of Radiology, University Medical CenterErasmus MCRotterdamThe Netherlands
  5. 5.Arthritis Research UK Primary Care CenterPrimary Care Sciences, Keele UniversityStaffordshireUnited Kingdom
  6. 6.Department of Neurology and Neurosurgery, University Medical Center UtrechtRudolf Magnus Institute of NeuroscienceUtrechtThe Netherlands

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