MRI findings of disc protrusion , nerve root displacement or compression , disc degeneration , and high intensity zone are all associated with LBP , but individually , none of these abnormalities provides a strong indication that LBP is attributable to underlying pathology .
This limits their value in refining epidemiological case definitions for LBP
OBJECTIVE to assess how confidently  low back pain ( LBP ) can be attributed to abnormalities on magnetic resonance imaging ( MRI ) , and thereby explore the potential value of MRI abnormalities in refining case definition for mechanical LBP in epidemiological research .
SUMMARY OF BACKGROUND DATA most epidemiological studies of mechanical LBP have defined cases only by reported symptoms , but it is possible that the potency of causes differs depending on whether there is demonstrable underlying spinal pathology .
Spinal stenosis, back pain, or no symptoms at all? A masked study comparing radiologic and electrodiagnostic diagnoses to the clinical impression.
OBJECTIVE To assess the relations between clinical ly recognized lumbar spinal stenosis and the conclusions of masked radiologists and electrodiagnosticians . DESIGN Prospect i ve , masked , double-controlled trial . SETTING University spine center . PARTICIPANTS One hundred fifty persons age 55 to 80 years with or without back pain and with or without magnetic resonance imaging (MRI)-demonstrated stenosis , screened for neuropathy risk , previous surgery , or cancer . INTERVENTIONS Question naires on pain and function ; ambulation testing and physical examination ; and masked electrodiagnotics and MRI . MAIN OUTCOME MEASURE Diagnostic impressions of the examining clinician , radiologist , and electrodiagnostician . RESULTS Following application of post hoc exclusion criteria and elimination of patients due to incomplete or inadequate test data , the clinical diagnosis was lumbar stenosis in 50 subjects , back pain in 44 subjects , and no pain in 32 subjects . Radiologic and clinical impression had no relation ( P = .80 vs asymptomatic , P = .99 vs back pain controls ) . Electrodiagnostic impression trended to relate to clinical impression ( P = .14 vs asymptomatic , P = .09 vs back pain ) . Retrospective application of age-related electrodiagnostic norms for paraspinal electromyographic and limb motor unit changes , established in this study , reclassified 13 of the 17 asymptomatic persons whom the electrodiagnostician thought had stenosis . The clinical impression did correspond to history and physical examination findings typically associated with spinal stenosis and to the independent impression of a neurosurgeon who examined MRI and clinical , but not to the electrodiagnostic data . CONCLUSIONS The impression obtained from an MRI scan does not determine whether lumbar stenosis is a cause of pain . Electrodiagnostic consultation may be useful , especially if age-related norms obtained in this study are applied
MRI findings of disc protrusion , nerve root displacement or compression , disc degeneration , and high intensity zone are all associated with LBP , but individually , none of these abnormalities provides a strong indication that LBP is attributable to underlying pathology .
This limits their value in refining epidemiological case definitions for LBP
OBJECTIVE to assess how confidently  low back pain ( LBP ) can be attributed to abnormalities on magnetic resonance imaging ( MRI ) , and thereby explore the potential value of MRI abnormalities in refining case definition for mechanical LBP in epidemiological research .
SUMMARY OF BACKGROUND DATA most epidemiological studies of mechanical LBP have defined cases only by reported symptoms , but it is possible that the potency of causes differs depending on whether there is demonstrable underlying spinal pathology .