title: MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  Imaging features of spine degeneration are common in symptomatic and asymptomatic individuals. We compared the prevalence of MR imaging features of lumbar spine degeneration in adults 50 years of age and younger with and without self-reported low back pain.
  
  
  METHODS
  We performed a meta-analysis of studies reporting the prevalence of degenerative lumbar spine MR imaging findings in asymptomatic and symptomatic adults 50 years of age or younger. Symptomatic individuals had axial low back pain with or without radicular symptoms. Two reviewers evaluated each article for the following outcomes: disc bulge, disc degeneration, disc extrusion, disc protrusion, annular fissures, Modic 1 changes, any Modic changes, central canal stenosis, spondylolisthesis, and spondylolysis. The meta-analysis was performed by using a random-effects model.
  
  
  RESULTS
  An initial search yielded 280 unique studies. Fourteen (5.0%) met the inclusion criteria (3097 individuals; 1193, 38.6%, asymptomatic; 1904, 61.4%, symptomatic). Imaging findings with a higher prevalence in symptomatic individuals 50 years of age or younger included disc bulge (OR, 7.54; 95% CI, 1.28-44.56; P = .03), spondylolysis (OR, 5.06; 95% CI, 1.65-15.53; P < .01), disc extrusion (OR, 4.38; 95% CI, 1.98-9.68; P < .01), Modic 1 changes (OR, 4.01; 95% CI, 1.10-14.55; P = .04), disc protrusion (OR, 2.65; 95% CI, 1.52-4.62; P < .01), and disc degeneration (OR, 2.24; 95% CI, 1.21-4.15, P = .01). Imaging findings not associated with low back pain included any Modic change (OR, 1.62; 95% CI, 0.48-5.41, P = .43), central canal stenosis (OR, 20.58; 95% CI, 0.05-798.77; P = .32), high-intensity zone (OR = 2.10; 95% CI, 0.73-6.02; P = .17), annular fissures (OR = 1.79; 95% CI, 0.97-3.31; P = .06), and spondylolisthesis (OR = 1.59; 95% CI, 0.78-3.24; P = .20).
  
  
  CONCLUSIONS
  Meta-analysis demonstrates that MR imaging evidence of disc bulge, degeneration, extrusion, protrusion, Modic 1 changes, and spondylolysis are more prevalent in adults 50 years of age or younger with back pain compared with asymptomatic individuals.
authors.affiliation: From the Department of Radiology (W.B., F.E.D., C.M.C., D.F.K., P.H.L.) brinjikji.waleed@mayo.edu.
authors.forename: W
authors.identifier: http://orcid.org/0000-0001-5271-5524
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: From the Department of Radiology (W.B., F.E.D., C.M.C., D.F.K., P.H.L.).
authors.forename: F E
authors.identifier: http://orcid.org/0000-0001-9458-8017
authors.initials: FE
authors.lastname: Diehn
authors.affiliation: Department of Neurological Surgery and Health Services, Comparative Effectiveness Cost and Outcomes Research Center (J.G.J.) Department of Radiology (J.G.J.), University of Washington, Seattle, Washington.
authors.forename: J G
authors.initials: JG
authors.lastname: Jarvik
authors.affiliation: From the Department of Radiology (W.B., F.E.D., C.M.C., D.F.K., P.H.L.).
authors.forename: C M
authors.initials: CM
authors.lastname: Carr
authors.affiliation: From the Department of Radiology (W.B., F.E.D., C.M.C., D.F.K., P.H.L.).
authors.forename: D F
authors.identifier: http://orcid.org/0000-0002-8495-0040
authors.initials: DF
authors.lastname: Kallmes
authors.affiliation: Center for Science of Healthcare Delivery (M.H.M.), Mayo Clinic, Rochester, Minnesota.
authors.forename: M H
authors.identifier: http://orcid.org/0000-0001-5502-5975
authors.initials: MH
authors.lastname: Murad
authors.affiliation: From the Department of Radiology (W.B., F.E.D., C.M.C., D.F.K., P.H.L.).
authors.forename: P H
authors.identifier: http://orcid.org/0000-0003-4660-7644
authors.initials: PH
authors.lastname: Luetmer
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology*; D017116:Low Back Pain / Q000209:etiology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015995:Prevalence