Do MRI findings identify patients with low back pain or sciatica who respond better to particular interventions? A systematic review.
OBJECTIVE
Magnetic resonance imaging (MRI) can reveal a range of degenerative findings and anatomical abnormalities; however, the clinical importance of these remains uncertain and controversial. We aimed to investigate if the presence of MRI findings identifies patients with low back pain (LBP) or sciatica who respond better to particular interventions.


METHODS
MEDLINE, EMBASE and CENTRAL databases were searched. We included RCTs investigating MRI findings as treatment effect modifiers for patients with LBP or sciatica. We excluded studies with specific diseases as the cause of LBP. Risk of bias was assessed using the criteria of the Cochrane Back Review Group. Each MRI finding was examined for its individual capacity for effect modification.


RESULTS
Eight published trials met the inclusion criteria. The methodological quality of trials was inconsistent. Substantial variability in MRI findings, treatments and outcomes across the eight trials prevented pooling of data. Patients with Modic type 1 when compared with patients with Modic type 2 had greater improvements in function when treated by Diprospan (steroid) injection, compared with saline. Patients with central disc herniation when compared with patients without central disc herniation had greater improvements in pain when treated by surgery, compared with rehabilitation.


CONCLUSIONS
Although individual trials suggested that some MRI findings might be effect modifiers for specific interventions, none of these interactions were investigated in more than a single trial. High quality, adequately powered trials investigating MRI findings as effect modifiers are essential to determine the clinical importance of MRI findings in LBP and sciatica (
CRD42013006571).
Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, P.O. Box M201, Missenden Rd, Sydney, NSW, 2050, Australia. dsteffens@georgeinstitute.org.au.|Department of Physiotherapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. dsteffens@georgeinstitute.org.au.
Daniel
D
Steffens
Discipline of Physiotherapy, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
Mark J
MJ
Hancock
Department of Physiotherapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Leani S M
LS
Pereira
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.|Research Department, The Spine Centre of Southern Denmark, Institute of Regional Health Services Research, University of Southern Denmark, Middelfart, Denmark.
Peter M
PM
Kent
Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, P.O. Box M201, Missenden Rd, Sydney, NSW, 2050, Australia.
Jane
J
Latimer
Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, P.O. Box M201, Missenden Rd, Sydney, NSW, 2050, Australia.
Chris G
CG
Maher
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001623:Betamethasone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004338:Drug Combinations; D006801:Humans; D007270:Injections, Intra-Articular; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000628:therapy*; D017116:Low Back Pain / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D019637:Orthopedic Procedures; D026741:Physical Therapy Modalities; D011379:Prognosis; D012585:Sciatica / Q000473:pathology / Q000628:therapy*
D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; C032812:betamethasone dipropionate, betamethasone sodium phosphate drug combination; D001623:Betamethasone
Low back pain; Magnetic resonance imaging; Randomised controlled trial; Sciatica; Subgroup analysis; Systematic review