Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; a systematic review

Chiropr Man Therap. 2018 Aug 21:26:37. doi: 10.1186/s12998-018-0207-x. eCollection 2018.


Main text: We aim to summarize the available evidence on the diagnostic accuracy of imaging (index test) compared to surgery (reference test) for identifying lumbar disc herniation (LDH) in adult patients.For this systematic review we searched MEDLINE, EMBASE and CINAHL (June 2017) for studies that assessed the diagnostic accuracy of imaging for LDH in adult patients with low back pain and surgery as the reference standard. Two review authors independently selected studies, extracted data and assessed risk of bias. We calculated summary estimates of sensitivity and specificity using bivariate analysis, generated linked ROC plots in case of direct comparison of diagnostic imaging tests and assessed the quality of evidence using the GRADE-approach.We found 14 studies, all but one done before 1995, including 940 patients. Nine studies investigated Computed Tomography (CT), eight myelography and six Magnetic Resonance Imaging (MRI). The prior probability of LDH varied from 48.6 to 98.7%. The summary estimates for MRI and myelography were comparable with CT (sensitivity: 81.3% (95%CI 72.3-87.7%) and specificity: 77.1% (95%CI 61.9-87.5%)). The quality of evidence was moderate to very low.

Conclusions: The diagnostic accuracy of CT, myelography and MRI of today is unknown, as we found no studies evaluating today's more advanced imaging techniques. Concerning the older techniques we found moderate diagnostic accuracy for all CT, myelography and MRI, indicating a large proportion of false positives and negatives.

Keywords: Diagnostic accuracy; Diagnostic imaging; Low back pain; Lumbar disc herniation; Systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Humans
  • Intervertebral Disc Displacement / diagnosis
  • Intervertebral Disc Displacement / diagnostic imaging*
  • Low Back Pain / diagnosis
  • Low Back Pain / diagnostic imaging*
  • Lumbosacral Region / diagnostic imaging
  • Magnetic Resonance Imaging / standards*
  • Myelography / standards*
  • Randomized Controlled Trials as Topic
  • Sciatica / diagnosis
  • Sciatica / diagnostic imaging*
  • Tomography Scanners, X-Ray Computed / standards*