Disc Degeneration Science in Brief Chiropractic Research

MRI Findings, Disc Degeneration and Low Back Pain

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The Study: MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis.

The Facts:

a. Both symptomatic and non symptomatic people have visible degenerative changes on imaging.

b. The authors looked at studies that reported on the degenerative changes in asymptomatic and symptomatic subjects.  

c. The subjects were age 50 or younger.  

d. The studies used MRIs as the imaging.  

e. The 14 studies reviewed looked at over 3000 subjects.

f. “Multiple previous studies have demonstrated a higher prevalence of disc findings in symptomatic-verses-asymptomatic individuals.  

g. “Disc extrusions are rare in asymptomatic populations.” 

h. Most studies find less than 2% of asymptomatic subjects have disc extrusions.  

i. In symptomatic populations the prevalence of disc extrusions is 5 to 10%. 

j. The authors indicate that disc bulges are often considered to be incidental findings and that a surprising finding of their study “was that disc bulge had a strong association with low back pain.  

k. This study found that 6% of asymptomatic subjects had disc bulges while 43% of the symptomatic subjects had disc bulges. 

l. The authors warn that “the association between these degenerative findings and pain should not be interpreted as causation.” They can be thought of as “candidate biomarkers for low back pain in…” patients younger than 50.  

Take Home:

The authors conclude that: “disc bulge, degeneration, extrusion, protrusion, Modic 1 changes, and spondylolysis” are more common in subjects with low back pain in the 50 years or younger group than in those without low back pain.

Reviewer’s Comments:

I really have little to say about this other than it seems to me that over and over again we see studies that indicate that often the closer spines are to” normal factory issue” the better it is for the subject and that physical changes predispose the patient to symptoms. I’m for appropriately aligned, non degenerated, normally functioning spines. But isn’t the quest for that what chiropractic is all about? 

Reviewer: Roger Coleman DC  

Editor: Mark R. Payne DC

Reference: Brinjiki W, Diehn FE, Jarvik JG, carr CM, Kallme DF, Murad MH, Luetmer PH. MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis.AJNR, Am J Neuroradiol 2015 Sep 10. [Epub ahead of print]

Link to Abstract: http://www.ncbi.nlm.nih.gov/pubmed/26359154

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