Factors in the Diagnosis of Disc Herniations

Low back pain is a complex condition, and accurate diagnosis can be difficult. A current study examined a group of “Forty-six patients with low back pain and sciatica severe enough to require a discectomy” and 46 asymptomatic volunteers who were matched for age and work-related risk factors (heavy lifting, twisting and bending, vibration, or sedentary). Both groups were given a complete clinical exam, MRI, and psychological questionnaires.

MRI findings: “In 76% of the asymptomatic volunteers a disc herniation (i.e., protrusion, extrusion, or sequestration) was present at least at one level...In all, 85% of the matched control subjects without previous back pain exhibited disc degeneration at least at one level. In the patient group, 96% showed at least one degenerative change.” Patients, however, had an 82% rate of neural compromise, while controls had only a 21% rate.

The authors found that pain patients were more likely to have signs of neurological compromise, were more likely to be depressed or anxious, were more likely to be married, and had higher levels of work stress.

The study also warns against using MRI alone as indications for surgery. For instance, if surgery is based on MRI-detected disc herniations alone, there is a false positive rate of 76%;for MRI-detected disc degeneration, there is a false positive rate of 85%.

Boos N, Rieder R, Schade V, et al. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations. Spine 1996;20(24):2613-2625.

 

 

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