title: Degenerative magnetic resonance imaging changes in patients with chronic low back pain: a systematic review.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  To systematically search for critically appraise and summarize studies that (1) evaluated the association between degenerative magnetic resonance imaging (MRI) changes and chronic low back pain (CLBP) and (2) compared surgical and nonsurgical treatment of these degenerative MRI changes.
  
  
  BACKGROUND
  The role of routine MRI in patients with CLBP is unclear. It is also uncertain whether or not surgical treatment of degenerative MRI changes results in alleviation of back pain.
  
  
  METHODS
  Systematic literature searches were conducted in PubMed for studies published through March 1, 2011. To evaluate whether MRI degenerative changes are associated with CLBP, studies that were designed to compare the prevalence of MRI changes among subjects with and without CLBP were sought. The prevalence odds ratio was used to compare the odds of degenerative MRI findings in subjects with CLBP to the odds of such findings among those without CLBP. To evaluate whether surgical treatment of degenerative MRI changes is associated with different outcomes compared with nonsurgical treatment, comparative studies were sought. The GRADE system as applied to describe the strength of the overall body of evidence.
  
  
  RESULTS
  Regarding the association of degenerative changes on MRI and CLBP, five studies were included, all of which were cross-sectional in design. On the basis of these studies, a statistically significant association was found in all but one study regarding the presence of disc degeneration and CLBP (odds ratio range: 1.8-2.8). The overall strength of evidence across studies was considered to be insufficient, however. No comparative studies of surgical versus nonsurgical treatment of degenerative MRI changes were identified.
  
  
  CONCLUSIONS
  Although there may be an association between degenerative MRI changes and CLBP, it is unknown if these estimates accurately represent the association given the quality of included studies, lack of a direct link between degenerative MRI changes and CLBP, and heterogeneity across studies. Thus, a strong recommendation against the routine use of MRI for CLBP evaluation is made. Since there are no data evaluating the efficacy of the surgical treatment of degenerative MRI changes, a strong recommendation is made against the surgical treatment of CLBP based solely upon degenerative MRI changes.
  
  
  CONCLUSIONS
  
  
  
  CONCLUSIONS
  There is insuffi cient evidence to support the routine use of MRI in patients with CLBP.
  
  
  CONCLUSIONS
  Strong
  
  
  CONCLUSIONS
  Surgical treatment of CLBP based exclusively on MRI fi ndings of degenerative changes is not recommended.
  
  
  CONCLUSIONS
  Strong.
authors.affiliation: Department of Neurosurgery, University of California, San Francisco, CA 94143, USA. choud@neurosurg.ucsf.edu
authors.forename: Dean
authors.initials: D
authors.lastname: Chou
authors.forename: Dino
authors.initials: D
authors.lastname: Samartzis
authors.forename: Carlo
authors.initials: C
authors.lastname: Bellabarba
authors.forename: Alpesh
authors.initials: A
authors.lastname: Patel
authors.forename: Keith D K
authors.initials: KD
authors.lastname: Luk
authors.forename: Jeannette M Schenk
authors.initials: JM
authors.lastname: Kisser
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Skelly
mesh_terms: D059350:Chronic Pain / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D019317:Evidence-Based Medicine; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D016017:Odds Ratio; D019637:Orthopedic Procedures; D010147:Pain Measurement; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013131:Spine / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome