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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 Wassenaar
  • 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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Diagnostic accuracy Systematic review MRI Low back pain Diagnostic imaging 

Abbreviations

LBP

Low back pain

MRI

Magnetic resonance imaging

HNP

Herniated nucleus pulposus

Notes

Acknowledgments

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.

References

  1. 1.
    Burton AK, Balague F, Cardon G et al (2006) Chapter 2. European guidelines for prevention in low back pain: November 2004. Eur Spine J 15(Suppl 2):S136–S168PubMedCrossRefGoogle Scholar
  2. 2.
    Ehrlich GE (2003) Low back pain 45. Bull World Health Organ 81:671–676PubMedGoogle Scholar
  3. 3.
    Elders LA, Burdorf A (2004) Prevalence, incidence, and recurrence of low back pain in scaffolders during a 3-year follow-up study 42. Spine (Phila Pa 1976.) 29:E101–E106CrossRefGoogle Scholar
  4. 4.
    Chou R, Qaseem A, Snow V et al (2007) Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 147:478–491PubMedGoogle Scholar
  5. 5.
    van TM, Becker A, Bekkering T et al (2006) Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 15(Suppl 2):S169–S191Google Scholar
  6. 6.
    Kendrick D, Fielding K, Bentley E et al (2001) Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. BMJ 322:400–405PubMedCrossRefGoogle Scholar
  7. 7.
    Ash LM, Modic MT, Obuchowski NA et al (2008) Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR Am J Neuroradiol 29:1098–1103PubMedCrossRefGoogle Scholar
  8. 8.
    Loblaw DA, Perry J, Chambers A et al (2005) Systematic review of the diagnosis and management of malignant extradural spinal cord compression: the Cancer Care Ontario Practice Guidelines Initiative’s Neuro-Oncology Disease Site Group 13. J Clin Oncol 23:2028–2037PubMedCrossRefGoogle Scholar
  9. 9.
    Tsiodras S, Falagas ME (2006) Clinical assessment and medical treatment of spine infections. Clin Orthop Relat Res 444:38–50PubMedCrossRefGoogle Scholar
  10. 10.
    Jarvik JG, Deyo RA (2002) Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med 137:586–597PubMedGoogle Scholar
  11. 11.
    Deyo RA, Bigos SJ, Maravilla KR (1989) Diagnostic imaging procedures for the lumbar spine. Ann Intern Med 111:865–867PubMedGoogle Scholar
  12. 12.
    Ozturk C, Karadereler S, Ornek I et al (2010) The role of routine magnetic resonance imaging in the preoperative evaluation of adolescent idiopathic scoliosis. Int Orthop 34:543–546PubMedCrossRefGoogle Scholar
  13. 13.
    Chou R, Fu R, Carrino JA et al (2009) Imaging strategies for low-back pain: systematic review and meta-analysis 9. Lancet 373:463–472PubMedCrossRefGoogle Scholar
  14. 14.
    Jarvik JG, Hollingworth W, Martin B et al (2003) Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial. JAMA 289:2810–2818PubMedCrossRefGoogle Scholar
  15. 15.
    Lurie JD, Birkmeyer NJ, Weinstein JN (2003) Rates of advanced spinal imaging and spine surgery. Spine (Phila Pa 1976.) 28:616–620Google Scholar
  16. 16.
    Thornbury JR, Fryback DG, Turski PA et al (1993) Disk-caused nerve compression in patients with acute low back pain: diagnosis with MR, CT myelography and plain CT. Radiology 186:731–738PubMedGoogle Scholar
  17. 17.
    Jensen MC, Brant-Zawadzki MN, Obuchowski N et al (1994) Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 331:69–73PubMedCrossRefGoogle Scholar
  18. 18.
    van Tulder MW, Assendelft WJ, Koes BW et al (1997) Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies. Spine (Phila Pa 1976.) 22:427–434CrossRefGoogle Scholar
  19. 19.
    Smidt N, Deeks J, Moore T (2005) Cochrane Handbook for Cochrane Reviews of Diagnostic Test Accuracy. The Cochrane Collaboration. Ref Type: GenericGoogle Scholar
  20. 20.
    Whiting P, Rutjes AW, Dinnes J et al (2004) Development and validation of methods for assessing the quality of diagnostic accuracy studies. Health Technol Assess 8:iii1–iii234Google Scholar
  21. 21.
    Juni P, Witschi A, Bloch R et al (1999) The hazards of scoring the quality of clinical trials for meta-analysis. JAMA 282:1054–1060PubMedCrossRefGoogle Scholar
  22. 22.
    Whiting P, Harbord R, Kleijnen J (2005) No role for quality scores in systematic reviews of diagnostic accuracy studies. BMC Med Res Methodol. 5:19PubMedCrossRefGoogle Scholar
  23. 23.
    Reitsma JB, Glas AS, Rutjes AW et al (2005) Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 58:982–990PubMedCrossRefGoogle Scholar
  24. 24.
    Bernard TN Jr (1994) Using computed tomography/discography and enhanced magnetic resonance imaging to distinguish between scar tissue and recurrent lumbar disc herniation. Spine (Phila Pa 1976.) 19:2826–2832CrossRefGoogle Scholar
  25. 25.
    Birney TJ, White JJ Jr, Berens D et al (1992) Comparison of MRI and discography in the diagnosis of lumbar degenerative disc disease. J Spinal Disord 5:417–423PubMedCrossRefGoogle Scholar
  26. 26.
    Bischoff RJ, Rodriguez RP, Gupta K et al (1993) A comparison of computed tomography-myelography, magnetic resonance imaging, and myelography in the diagnosis of herniated nucleus pulposus and spinal stenosis. J Spinal Disord 6:289–295PubMedCrossRefGoogle Scholar
  27. 27.
    Chawalparit O, Churojana A, Chiewvit P et al (2006) The limited protocol MRI in diagnosis of lumbar disc herniation. J Med Assoc Thai 89:182–189PubMedGoogle Scholar
  28. 28.
    Forristall RM, Marsh HO, Pay NT (1988) Magnetic resonance imaging and contrast CT of the lumbar spine. comparison of diagnostic methods and correlation with surgical findings. Spine (Phila Pa 1976.) 13:1049–1054CrossRefGoogle Scholar
  29. 29.
    Jackson RP, Cain JE Jr, Jacobs RR et al (1989) The neuroradiographic diagnosis of lumbar herniated nucleus pulposus: II. a comparison of computed tomography (CT), myelography, CT-myelography, and magnetic resonance imaging. Spine (Phila Pa 1976.) 14:1362–1367CrossRefGoogle Scholar
  30. 30.
    Aota Y, Niwa T, Yoshikawa K et al (2007) Magnetic resonance imaging and magnetic resonance myelography in the presurgical diagnosis of lumbar foraminal stenosis. Spine (Phila Pa 1976.) 32:896–903CrossRefGoogle Scholar
  31. 31.
    Diamond GA (1992) Off Bayes: effect of verification bias on posterior probabilities calculated using Bayes’ theorem 5. Med Decis.Making 12:22–31PubMedCrossRefGoogle Scholar
  32. 32.
    Mol BW, Lijmer JG, van der MJ et al (1999) Effect of study design on the association between nuchal translucency measurement and Down syndrome. Obstet Gynecol 94:864–869PubMedCrossRefGoogle Scholar
  33. 33.
    Jacobsen S, Gosvig KK, Sonne-Holm S (2006) Low back degeneration and radiology. Ugeskr.Laeger 168:769–773PubMedGoogle Scholar
  34. 34.
    Leeflang MM, Deeks JJ, Gatsonis C et al (2008) Systematic reviews of diagnostic test accuracy. Ann Intern Med 149:889–897PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Merel Wassenaar
    • 1
    • 6
  • 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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