Limited Association between Patient Symptoms and MRI Findings

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Limited Association between Patient Symptoms and MRI Findings

The relationship between anatomic impairment and symptoms of low back pain (LBP) remains speculative and controversial. Anatomic impairments of the intervertebral disc, radicular canal, and associated soft tissues are common, even in the absence of low back pain or lower extremity radiculopathy.

The authors of this study evaluated the relationship between patient-reported symptoms and MRI-confirmed anatomic impairment in 408 symptomatic subjects. Patients were referred by an orthopedist or neurosurgeon to be included in the study. Patients completed a survey and pain drawing, then underwent standardized MRI.
Although patients could be reliably classified on the basis of segmental pain distributions, there appeared to be little association between these pain distributions and impairments visible on lumbar MRI. The authors summarize their findings as the following key points:

Lumbar disc extrusion or ipsilateral severe nerve compression visible on MRI strongly predicts distal leg pain.
Mild-to-moderate nerve compression, disc degeneration or bulging, or spinal stenosis is not associated with any specific pain pattern.
Segmental distributions of pain can be reliably determined from pain drawings, but cannot be used to predict lumbar impairment.
Self-report of lower extremity weakness or dysthesia is not significantly related to any specific lumbar anatomic impairments visible on MRI.

Beattie PF, Meyers SP, Stratford P, et al. Associations between patient report of symptoms and anatomic impairment visible on lumbar magnetic resonance imaging. Spine, April 1, 2000:25(7), pp819-28.