The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ ( but not the facet joint ) as the source of low back pain .
Clinical practice guidelines state that the tissue source of low back pain can not be specified in the majority of patients .
However , there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain .
The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc , facet joint or sacroiliac joint ( SIJ ) as the source of low back pain .
Painful Lumbar Disk Derangement: Relevance of Endplate Abnormalities at MR Imaging.
PURPOSE To investigate the predictive value of magnetic resonance ( MR ) imaging of abnormalities of the lumbar intervertebral disks , particularly with adjacent endplate changes , to predict symptomatic disk derangement , with discography as the st and ard . MATERIAL S AND METHODS Fifty patients aged 28 - 50 years with chronic low back pain and without radicular leg pain underwent prospect i ve clinical examination and sagittal T1- and T2-weighted and transverse T2-weighted MR imaging . Subsequently , patients underwent lumbar discography with a pain provocation test ( 116 disks ) . MR images were evaluated for disk degeneration , a high-signal-intensity zone , and endplate abnormalities . Results of pain provocation at discography were rated independently of the image findings as concordant or as nonconcordant or painless . Sensitivity , specificity , positive predictive value ( PPV ) , and negative predictive value ( NPV ) were calculated to assess the clinical relevance of MR abnormalities . RESULTS Normal disks on MR images were generally not painful at provocative discography ( NPV , 98 % ) . Disk degeneration ( sensitivity , 98 % ; specificity , 59 % ; PPV , 63 % ) and a high-signal-intensity zone ( sensitivity , 27 % ; specificity , 85 % ; PPV , 56 % ) were not helpful in the identification of symptomatic disk derangement . When only moderate and severe type I and type II endplate abnormalities were considered abnormal , all injected disks caused concordant pain with provocation ( sensitivity , 38 % ; specificity , 100 % ; PPV , 100 % ) . CONCLUSION Moderate and severe endplate abnormalities appear be useful in the prediction of painful disk derangement in patients with symptomatic low back pain
The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ ( but not the facet joint ) as the source of low back pain .
Clinical practice guidelines state that the tissue source of low back pain can not be specified in the majority of patients .
However , there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain .
The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc , facet joint or sacroiliac joint ( SIJ ) as the source of low back pain .