Background The relation between abnormalities in the lumbarspine and low back pain is controversial. We examined the prevalenceof abnormal findings on magnetic resonance imaging (MRI) scansof the lumbar spine in people without back pain.
Methods We performed MRI examinations on 98 asymptomatic people.The scans were read independently by two neuroradiologists whodid not know the clinical status of the subjects. To reducethe possibility of bias in interpreting the studies, abnormalMRI scans from 27 people with back pain were mixed randomlywith the scans from the asymptomatic people. We used the followingstandardized terms to classify the five intervertebral disksin the lumbosacral spine: normal, bulge (circumferential symmetricextension of the disk beyond the interspace), protrusion (focalor asymmetric extension of the disk beyond the interspace),and extrusion (more extreme extension of the disk beyond theinterspace). Nonintervertebral disk abnormalities, such as facetarthropathy, were also documented.
Results Thirty-six percent of the 98 asymptomatic subjects hadnormal disks at all levels. With the results of the two readingsaveraged, 52 percent of the subjects had a bulge at at leastone level, 27 percent had a protrusion, and 1 percent had anextrusion. Thirty-eight percent had an abnormality of more thanone intervertebral disk. The prevalence of bulges, but not ofprotrusions, increased with age. The most common nonintervertebraldisk abnormalities were Schmorl's nodes (herniation of the diskinto the vertebral-body end plate), found in 19 percent of thesubjects; annular defects (disruption of the outer fibrous ringof the disk), in 14 percent; and facet arthropathy (degenerativedisease of the posterior articular processes of the vertebrae),in 8 percent. The findings were similar in men and women.
Conclusions On MRI examination of the lumbar spine, many peoplewithout back pain have disk bulges or protrusions but not extrusions.Given the high prevalence of these findings and of back pain,the discovery by MRI of bulges or protrusions in people withlow back pain may frequently be coincidental.
Source Information
From Hoag Memorial Hospital, Newport Beach, Calif. (M.C.J., M.N.B.-Z., D.M.); Riverside MRI, Riverside, Calif. (M.C.J.); and the Cleveland Clinic, Cleveland (N.O., M.T.M., J.S.R.).
Address reprint requests to Dr. Brant-Zawadzki at Hoag Memorial Hospital, Department of Radiology, 301 Newport Blvd., Newport Beach, CA 92663.
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