title: Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women.
abstract: METHODS
  Cross-sectional cohort study of a general population.
  
  
  OBJECTIVE
  To investigate "abnormal" lumbar spine magnetic resonance imaging (MRI) findings, and their prevalence and associations with low back pain (LBP).
  
  
  BACKGROUND
  The clinical relevance of various "abnormal" findings in the lumbar spine is unclear. Distinguishing between inevitable age-related findings and degenerative findings with deleterious consequences is a challenge.
  
  
  METHODS
  Lumbar spine MRI was obtained in 412, 40-year-old individuals. Predefined "abnormal" MRI findings were interpreted without any knowledge of patient symptoms. Associations between MRI abnormalities and LBP were calculated using odds ratios. The "overall picture" of each MRI finding was established on the basis of the frequencies, diagnostic values, and the strength and consistency of associations.
  
  
  RESULTS
  Most "abnormal" MRI findings were found at the lowest lumbar levels. Irregular nucleus shape and reduced disc height were common (>50% of individuals). Relatively common (25% to 50%) were hypointense disc signal, anular tears, high intensity zones, disc protrusions, endplate changes, zygapophyseal joint degeneration, asymmetry, and foraminal stenosis. Nerve root compromise, Modic changes, central spinal stenosis, and anterolisthesis/retrolisthesis were rare (<25%). Most strongly associated with LBP were Modic changes and anterolisthesis (odds ratios >4). Significantly positive associations with all LBP variables were seen for hypointense disc signals, reduced disc height, and Modic changes. All disc "abnormalities" except protrusion were moderately associated with LBP during the past year.
  
  
  CONCLUSIONS
  Most degenerative disc "abnormalities" were moderately associated with LBP. The strongest associations were noted for Modic changes and anterolisthesis. Further studies are needed to define clinical relevance.
authors.affiliation: The Back Research Center, Backcenter Funen, Ringe, Denmark. pkrj@shf.fyns-amt.dk
authors.forename: Per
authors.initials: P
authors.lastname: Kjaer
authors.forename: Charlotte
authors.initials: C
authors.lastname: Leboeuf-Yde
authors.forename: Lars
authors.initials: L
authors.lastname: Korsholm
authors.forename: Joan Solgaard
authors.initials: JS
authors.lastname: Sorensen
authors.forename: Tom
authors.initials: T
authors.lastname: Bendix
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000453:epidemiology / Q000473:pathology; D017116:Low Back Pain / Q000175:diagnosis* / Q000453:epidemiology; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011795:Surveys and Questionnaires