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Symptom-imaging correlation in lumbar spine pain

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Abstract

Lumbar spine MRI is associated with a high prevalence of morphological abnormalities in both symptomatic and asymptomatic individuals. A difficult challenge, therefore, is distinguishing the relevant findings causing symptoms from incidental findings. The accurate diagnosis of pain generator is important because misdiagnosis can negatively impact patient management and outcome. Spine physicians use clinical symptoms and signs to interpret lumbar spine MRI and make treatment decisions. Symptom-MRI correlation enables the targeted inspection of images for pain generator. Radiologists can also use clinical information to improve diagnostic confidence and the value of dictated reports. Because high-quality clinical information may be difficult to obtain, radiologists often generate lists of lumbar spine abnormalities that are otherwise difficult to rank as pain generators. Based on the literature review, this article attempts to distinguish the MRI abnormalities that may represent incidental findings from the abnormalities that are more commonly associated with lumbar spine-related symptoms.

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  1. Department of Radiology, Massachusetts General Hospital, 55 Fruit St, YAW 6030, Boston, MA, 02114, USA

    Rene Balza & William E. Palmer

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Key points

• Incidental findings are difficult to distinguish from true pain generators in symptomatic individuals.

• Central canal stenosis, even when severe, correlates poorly with clinical symptoms.

• Foraminal stenosis, unless severe, correlates poorly with clinical symptoms.

• Facet joint degenerative changes are more closely associated with clinical symptoms when bone marrow edema, effusion, and periarticular inflammation correlate positively with concordant pain provocation on physical examination.

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Balza, R., Palmer, W.E. Symptom-imaging correlation in lumbar spine pain. Skeletal Radiol 52, 1901–1909 (2023). https://doi.org/10.1007/s00256-023-04305-8

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