Lumbar Spine Lesions Detected by MRI: Which Ones Matter?

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Lumbar Spine Lesions Detected by MRI: Which Ones Matter?

Many asymptomatic patients have abnormal findings in the lumbar spine when they undergo magnetic resonance (MR) imaging. This can be frustrating for the clinician because sometimes low back pain may be caused by these lesions. Yet, no studies have been conducted to determine which lesions are predictive of low back pain in symptomatic patients.

The purpose of this study was to use MR to identify the abnormalities of the lumbar spine that have a low prevalence in asymptomatic patients and thereby determine the findings that are predictive of low back pain in symptomatic patients.
MR images were obtained from 60 asymptomatic volunteers (aged 20-50) and evaluated independently by 2 musculoskeletal radiologists to identify intervertebral disc abnormalities, end plate abnormalities, and osteoarthritis of the facet joints.
The relevant findings included disc bulging or disc protrusion in 42 (14%) and 48 (16%) of the intervertebral spaces in 37 (62%) and 40 (67%) subjects, respectively. High-signal-intensity zones were found in about half as many instances. Disc extrusions were even less common and there were no disc sequestrations, a single nerve root compression, few end plate abnormalities, and no severe osteoarthritis.
Conclusion: Disc extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints are rare in patients younger than 50 years and may be predictive of low back pain in symptomatic patients under age 50. Disc bulging and protrusion and high-intensity zones are common in asymptomatic patients under 50 years old and are probably not predictive of low back pain in symptomatic patients in the same age category.
Weishaupt, D; Zanetti, M; Hodler, J; Boos, N. MR Imaging of the lumbar spine: Prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology. Dec. 1998; 209(3), pp661-6.