Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Indian J Med Res. 2017 Jun;145(6):796-803. doi: 10.4103/ijmr.IJMR_1653_14.
BACKGROUND & OBJECTIVES: Magnetic resonance imaging (MRI) is frequently done for the evaluation of chronic low backache (CLBA), however, its significance in Indian patients has not been evaluated. We report here the MRI findings in patients with CLBA and their sensitivity and specificity with clinical evidence of radiculopathy and localized CLBA as well as correlate these with pain severity and disability.
Seventy two patients with CLBA aged 20-70 yr without trauma, infection, tumour, metastasis and vascular malformation were included in the study. Their demographic characteristics, lifestyle, education and employment were noted. Lumbosacral MRI was carried out and 19 MRI parameters at six levels (D12-L1-L5-S1) were noted. The severity of pain was assessed by Numeric Rating Scale (NRS, 0-10) and disability by Oswestry Disability Index (ODI).
MRI was abnormal in all patients, the most common being disc desiccation (90.3%) followed by facet joint arthropathy (FJA; 75%) and nerve root compression (NRC; 72.2%). Endplate changes and high-intensity zone were noted in 58 and 50 per cent of patients, respectively. One-third patients with FJA, however, were below 30 yr of age. NRC on MRI had 61.3 per cent sensitivity and 10 per cent specificity with clinical radiculopathy. FJA had 60.7 per cent sensitivity and 15.9 per cent specificity with localized CLBA. None of the MRI parameters and MRI sum score correlated with NRS and ODI. On multivariate analysis, NRS was independent predictor of ODI (odds ratio 0.58, 95% confidence interval 0.35-0.98, P=0.04).
INTERPRETATION & CONCLUSIONS: In patients with CLBA, NRC on MRI showed poor specificity with corresponding clinical radiculopathy and FJA with localized backache. None of the MRI abnormality correlated with the severity of pain or disability.
磁共振成像（MRI）常用于评估慢性下腰痛（CLBA），但尚未评估其在印度患者中的意义。我们在此报告 CLBA 患者的 MRI 结果及其与神经根受压和局部 CLBA 的临床证据的敏感性和特异性，并将这些结果与疼痛严重程度和残疾相关联。
本研究纳入了 72 例年龄在 20-70 岁之间、无创伤、感染、肿瘤、转移和血管畸形的 CLBA 患者。记录了他们的人口统计学特征、生活方式、教育和就业情况。进行了腰骶部 MRI 检查，并记录了六个节段（D12-L1-L5-S1）的 19 个 MRI 参数。采用数字评分量表（NRS，0-10）评估疼痛严重程度，采用 Oswestry 残疾指数（ODI）评估残疾程度。
所有患者的 MRI 均异常，最常见的是椎间盘退变（90.3%），其次是小关节关节炎（FJA；75%）和神经根受压（NRC；72.2%）。58%和 50%的患者分别存在终板改变和高信号区。然而，有三分之一的 FJA 患者年龄在 30 岁以下。MRI 上的 NRC 对临床神经根病的敏感性为 61.3%，特异性为 10%。FJA 对局部 CLBA 的敏感性为 60.7%，特异性为 15.9%。MRI 参数和 MRI 总分与 NRS 和 ODI 均无相关性。多变量分析显示，NRS 是 ODI 的独立预测因素（比值比 0.58，95%置信区间 0.35-0.98，P=0.04）。
在 CLBA 患者中，MRI 上的 NRC 对相应的临床神经根病和 FJA 对局部腰痛的特异性较差。MRI 异常与疼痛严重程度或残疾均无相关性。
