title: Do more MRI findings imply worse disability or more intense low back pain? A cross-sectional study of candidates for lumbar disc prosthesis.
abstract: OBJECTIVE
  To examine whether combined magnetic resonance imaging (MRI) findings are related to the degree of disability and low back pain (LBP) in candidates for lumbar disc prosthesis surgery.
  
  
  METHODS
  This cross-sectional study included 170 disc prosthesis candidates (mean age 41 years; 88 women) with chronic non-radicular LBP and localized disc degeneration. Experienced radiologists rated Modic changes and disc findings at L4-S1 on pre-treatment MRIs. An MRI total score (0-10) for findings at L4/L5 plus L5/S1 was calculated for Modic type I and/or II changes, a posterior high intensity zone (HIZ) in the disc, dark/black nucleus pulposus signal, and ≥40 % disc height decrease. We analyzed the relationship of the MRI total score to the Oswestry Disability Index (ODI) (n = 170) and LBP intensity scores (0-100 visual analogue scale, n = 165) using multiple linear regression and adjusting for age, gender, body mass index, smoking, and anxiety/depression.
  
  
  RESULTS
  The MRI total score was not related to ODI (regression coefficient 0.12, p = 0.79) or LBP intensity (regression coefficient 0.64, p = 0.37). When individual MRI findings were analyzed, patients with HIZ at L5/S1 had slightly lower ODI scores (4.7 points, p = 0.02). In post hoc analyses, results remained unchanged after adding facet arthropathy to the MRI total score and adjusting also for physical workload and physical leisure-time activity.
  
  
  CONCLUSIONS
  The combined MRI findings were not related to the degree of disability or the intensity of LBP. These degenerative MRI findings cannot explain variation in pre-treatment disability and pain in patients with chronic LBP accepted for disc prosthesis surgery.
authors: Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway, linda.berg@kir.uib.no.
authors: Linda
authors: L
authors: Berg
authors: Christian
authors: C
authors: Hellum
authors: Øivind
authors: Ø
authors: Gjertsen
authors: Gesche
authors: G
authors: Neckelmann
authors: Lars Gunnar
authors: LG
authors: Johnsen
authors: Kjersti
authors: K
authors: Storheim
authors: Jens Ivar
authors: JI
authors: Brox
authors: Geir Egil
authors: GE
authors: Eide
authors: Ansgar
authors: A
authors: Espeland
mesh_terms: D000328:Adult; D015984:Causality; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D017116:Low Back Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D008159:Lumbar Vertebrae / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D009664:Norway / Q000453:epidemiology; D010147:Pain Measurement / Q000379:methods / Q000706:statistics & numerical data; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D059145:Total Disc Replacement / Q000295:instrumentation / Q000706:statistics & numerical data*; D016896:Treatment Outcome
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