Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies.
METHODS
A systematic review of published observational studies.


OBJECTIVE
To examine the causal relationship between radiographic findings and nonspecific low back pain.


BACKGROUND
The causal relationship between radiographic findings and nonspecific low back pain still is controversial.


METHODS
Two reviewers independently scored the methodologic quality of all relevant, available studies using a standardized set of criteria. The association between radiographic findings and nonspecific low back pain was expressed as an odds ratio with a corresponding 95% confidence interval.


RESULTS
Degeneration, defined by the presence of disc space narrowing, osteophytes, and sclerosis, turned out to be associated with nonspecific low back pain with odds ratios ranging from 1.2 to 3.3. Spondylolysis and spondylolisthesis, spina bifida, transitional vertebrae, spondylosis, and Scheuermann's disease did not appear to be associated with low back pain. The validity scores of the observational studies ranged from 0% to 91% of the maximum score. Only two studies used a prospective design, and most studies lacked control for confounding, an appropriate test for nonspecific low back pain, and blinded assessment of radiographs and low back pain status.


CONCLUSIONS
There is no firm evidence for the presence or absence of a causal relationship between radiographic findings and nonspecific low back pain.
van Tulder
M W
MW
Institute for Research in Extramural Medicine, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
Assendelft
W J
WJ
Koes
B W
BW
Bouter
L M
LM
D005069:Evaluation Studies as Topic; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016017:Odds Ratio; D011859:Radiography; D012107:Research Design; D013131:Spine / Q000000981:diagnostic imaging*