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Tapio Videman, MD, PhD et al ABSTRACT Studies using MRI have found a high
incidence of positive findings for disc problems in persons with no
history of LBP. Other studies
have shown a trend of increased LBP in persons with disc protrusion and/or
extrusion. Of all the
studies, the only one of statistical significance was for annular
ruptures, where 60% of those with an annular leak had a history of LBP
versus 21% of those without a leak. This study utilized 115 monozygotic
male twins, age range 35-69, to assess life history, current history, and
previous year history of LBP after adjusting for age and other variables.
By using monozygotic twin pairs, the evaluators were able to
control for the confounding effects of the combined role of genetics and
early family influences. MRI
was used in all individuals to determine the degree of annular disruption
and the reports of back pain history. Results found that decreased disc
height was associated with all back pain measures. Also, annular tears were associated with pain in the previous
12 months and with the lifetime incidence of LBP, along with the intensity
of the worst previous episode. The
presence of tears corresponded to a 50-90% increased risk for these
subjects. Endplate
irregularities, osteophytes, bulging, herniations, spinal stenosis, and
signal intensity did not have a correlation with any of the pain
parameters. COMMENTS When MRI’s became more commonly
used over 10 years ago, it was frustrating as to how many patients were
referred to PT for disc herniation, when their pain appeared to be clearly
caused by something else. As
the medical profession soon found out, most all people have some form of
disc deformity, and there is often little correlation with their
complaints and the MRI findings. This
study also supports that notion, with annular tears and loss of disc
height being the only traits related to LBP in these individuals.
Loss of disc height may be understandably a cause, as it results in
increased facet compression and increased instability, which have been
tied to LBP. The study was poorly written and
was quite tedious to read, requiring 2 reads to get a better grasp of what
the authors were trying to suggest. It
does remind us that what we see on a diagnostic test is not always going
to be what the patient is suffering from, and we should remember to treat
what we see clinically, and what the preponderance of the evidence
indicates.
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