Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain

Abstract

On MRI examination of the lumbar spine, many people without back pain have disk bulges or protrusions but not extrusions. Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.

Sciatica in the female patient: anatomical considerations, aetiology and review of the literature

“…MRI without the use of gadolinium chelates now allows detailed evaluation of HDD without exposure of the fetus to the potential negative effects of ionising radiation [65,104]. Abnormal disk encountered in asymptomatic pregnant women as well as the high prevalence of anatomic abnormalities discovered in asymptomatic people highlight the importance of careful correlation of symptoms and findings at MRI [20,92,104,170]. In the presence of symptomatic HDD, elective caesarean section may be the preferred route of delivery with the anticipation that increasing epidural venous pressure, which is an indirect measure of CSF pressure, could precipitate progressive neurological dysfunction [103].…”

“…Few cases of sacral fracture related to pregnancy have been reported in whom bone mineral density was not necessarily low [23,74,142,145,159]. Back pain, the commonest symptom related to pregnancy-associated osteoporosis, buttock pain and vertebral fracture seem to occur more often during the first pregnancy or shortly after delivery [91,92,94,152]. The prognosis is generally good and recurrence rare.…”

Characteristic dynamic differences between healthy and low back pain subjects

“…However, the functional disability associated with the clinical and anatomical ®ndings is a highly questionable matter. 5,6 The 3-D dynamometer used in the present study adds some useful objective information that can be of signi®cant help to the physicians in their functional evaluation.…”

“…1 The use of imaging methods such as X-ray, CT and MRI can help in the diagnosis of the anatomical abnormalities, but they contribute little to the understanding of the actual functional disability. 5,6 Systems such as computerized dynamometers and electromyography (EMG) can add valuable objective, dynamic data that can help the clinician to de®ne and assess the low back condition 7 ± 10 but they reveal little of the actual disabilities.…”

Reliability among clinicians diagnosing low back-related leg pain

“…However, the usefulness of MRI as a reference test has been questioned. Positive MRI findings can be found in asymptomatic people [7], patients with nerve root symptoms can have normal MRIs [8] and MRI findings fail to distinguish sciatica patients in terms of the symptom severity [9]. Literature suggests that in the absence of a well-accepted reference standard, expert clinical opinion may be considered an appropriate alternative for diagnosis, providing that it is reasonably reliable [10].…”