MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
BMC Musculoskelet Disord. 2011 Oct 14;12:234. doi: 10.1186/1471-2474-12-234.
It is possible that clinical outcome of low back pain (LBP) differs according to the presence or absence of spinal abnormalities on magnetic resonance imaging (MRI), in which case there could be value in using MRI findings to refine case definition of LBP in epidemiological research. We therefore conducted a longitudinal study to explore whether spinal abnormalities on MRI for LBP predict prognosis after 18 months.
A consecutive series of patients aged 20-64 years, who were investigated by MRI because of mechanical LBP (median duration of current episode 16.2 months), were identified from three radiology departments, and those who agreed completed self-administered questionnaires at baseline and after a mean follow-up period of 18.5 months (a mean of 22.2 months from MRI investigation). MRI scans were assessed blind to other clinical information, according to a standardised protocol. Associations of baseline MRI findings with pain and disability at follow-up, adjusted for treatment and for other potentially confounding variables, were assessed by Poisson regression and summarised by prevalence ratios (PRs) with their 95% confidence intervals (CIs).
Questionnaires were completed by 240 (74%) of the patients who had agreed to be followed up. Among these 111 men and 129 women, 175 (73%) reported LBP in the past four weeks, 89 (37%) frequent LBP, and 72 (30%) disabling LBP. In patients with initial disc degeneration there was an increased risk of frequent (PR 1.3, 95%CI 1.0-1.9) and disabling LBP (PR 1.7, 95%CI 1.1-2.5) at follow-up. No other associations were found between MRI abnormalities and subsequent outcome.
Our findings suggest that the MRI abnormalities examined are not major predictors of outcome in patients with LBP. They give no support to the use of MRI findings as a way of refining case definition for LBP in epidemiological research.
腰痛（LBP）的临床结果可能因磁共振成像（MRI）上是否存在脊柱异常而有所不同，如果是这样，那么在流行病学研究中使用 MRI 结果来细化 LBP 的病例定义可能具有价值。因此，我们进行了一项纵向研究，以探讨 MRI 对 LBP 的脊柱异常是否能预测 18 个月后的预后。
从三个放射科部门中确定了因机械性 LBP（当前发作的中位数持续时间为 16.2 个月）而接受 MRI 检查的连续系列 20-64 岁患者，那些同意在基线和平均 18.5 个月（从 MRI 检查开始的平均 22.2 个月）后完成自我管理问卷的患者完成了问卷。MRI 扫描根据标准化方案进行盲法评估，以评估基线 MRI 发现与随访时疼痛和残疾之间的关联，调整治疗和其他潜在混杂变量后，通过泊松回归进行评估，并以患病率比（PR）及其 95%置信区间（CI）进行总结。
同意进行随访的患者中有 240 名（74%）完成了问卷。在这 111 名男性和 129 名女性中，175 名（73%）报告在过去四周内有 LBP，89 名（37%）有频繁的 LBP，72 名（30%）有残疾的 LBP。在初始椎间盘退变的患者中，频繁（PR 1.3，95%CI 1.0-1.9）和致残性 LBP（PR 1.7，95%CI 1.1-2.5）的风险增加。在其他 MRI 异常与后续结果之间未发现其他关联。
我们的发现表明，所检查的 MRI 异常不是 LBP 患者结局的主要预测因素。它们不支持将 MRI 结果用作在流行病学研究中细化 LBP 病例定义的方法。
