Do more MRI findings imply worse disability or more intense low back pain? A cross-sectional study of candidates for lumbar disc prosthesis

Skeletal Radiol. 2013 Nov;42(11):1593-602. doi: 10.1007/s00256-013-1700-x. Epub 2013 Aug 28.


Objective: To examine whether combined magnetic resonance imaging (MRI) findings are related to the degree of disability and low back pain (LBP) in candidates for lumbar disc prosthesis surgery.

Materials and methods: This cross-sectional study included 170 disc prosthesis candidates (mean age 41 years; 88 women) with chronic non-radicular LBP and localized disc degeneration. Experienced radiologists rated Modic changes and disc findings at L4-S1 on pre-treatment MRIs. An MRI total score (0-10) for findings at L4/L5 plus L5/S1 was calculated for Modic type I and/or II changes, a posterior high intensity zone (HIZ) in the disc, dark/black nucleus pulposus signal, and ≥40 % disc height decrease. We analyzed the relationship of the MRI total score to the Oswestry Disability Index (ODI) (n = 170) and LBP intensity scores (0-100 visual analogue scale, n = 165) using multiple linear regression and adjusting for age, gender, body mass index, smoking, and anxiety/depression.

Results: The MRI total score was not related to ODI (regression coefficient 0.12, p = 0.79) or LBP intensity (regression coefficient 0.64, p = 0.37). When individual MRI findings were analyzed, patients with HIZ at L5/S1 had slightly lower ODI scores (4.7 points, p = 0.02). In post hoc analyses, results remained unchanged after adding facet arthropathy to the MRI total score and adjusting also for physical workload and physical leisure-time activity.

Conclusions: The combined MRI findings were not related to the degree of disability or the intensity of LBP. These degenerative MRI findings cannot explain variation in pre-treatment disability and pain in patients with chronic LBP accepted for disc prosthesis surgery.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Causality
  • Comorbidity
  • Cross-Sectional Studies
  • Disability Evaluation*
  • Female
  • Humans
  • Intervertebral Disc Degeneration / diagnosis*
  • Intervertebral Disc Degeneration / epidemiology
  • Intervertebral Disc Degeneration / surgery*
  • Low Back Pain / diagnosis*
  • Low Back Pain / epidemiology
  • Low Back Pain / prevention & control*
  • Lumbar Vertebrae / surgery
  • Magnetic Resonance Imaging / statistics & numerical data*
  • Male
  • Norway / epidemiology
  • Pain Measurement / methods
  • Pain Measurement / statistics & numerical data
  • Prevalence
  • Reproducibility of Results
  • Risk Assessment
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Total Disc Replacement / instrumentation
  • Total Disc Replacement / statistics & numerical data*
  • Treatment Outcome