01. tbl. 103. árg. 2017
MRI for diagnosis of low back pain: Usability, association with symptoms and influence on treatment
Segulómun við greiningu lendahryggsverkja: Nýting, samband við einkenni og áhrif á meðferð
Background: Non-specific low-back pain is a worldwide problem. More specific diagnosis could improve prognosis. Magnetic resonance imaging (MRI) became available in Akureyri Hospital in 2004 but its utilisation in diagnosing low-back pain has not been investigated.
Objective: To study the use of MRI in diagnosing low-back pain, correlation of the MRI outcomes with other clinical findings and its possible effects on treatment.
Methods: Retrospective, descriptive analysis of patients' journals. Included were all adult (18 years and older) residents of Akureyri who underwent low-back MRI in Akureyri Hospital in 2009.
Results: During 2009, 159 patients (82 women) underwent low-back MRI, mean age 51 years (18-88). The most common pathological findings were connected to the lumbar disk. Disk herniation was diagnosed in 38% of the patients, 77% at the L4-L5 or L5-S1 level. MRI results correlated poorly with symptoms and clinical findings. Treatment options for disk herniation were prescription of medications (70%), referrals to physiotherapy (67%) and orthopaedic surgeons (61%). Nine patients were operated. Among patients referred to physiotherapy, 49% were first examined with MRI and thus waited longer for referral than those referred directly to physiotherapy (p=0.008). One year after the MRI, recovery rate was 51%. Prognosis was better for patients referred to physiotherapy (p=0.024).
Conclusions: MRI seems to be used for general diagnosis of low-back pain. Symptoms and MRI results correlate poorly, emphasizing the need for the doctor´s thorough weighing of clinical and MRI findings when diagnosing low-back pain. Recovery rate of patients with lumbar disk herniation improves by physiotherapy. The general use of MRI might delay treatment.
1Reykjavik Physical Therapy, 2Orthopedic Unit, Akureyri Hospital, Iceland, 3Faculty of Medicine, Landspítali University Hospital, 4School of Health Sciences, University of Akureyri, 5Rehabilitation Unit, Akureyri Hospital, Iceland, 6Department of Medical Sciences, Lung- Allergy- and Sleep Research, Uppsala University, Sweden
Key words: Magnetic resonance imaging, clinical diagnosis, low-back pain, lumbar disk herniation, treatment, physiotherapy.
Correspondence: Gunnar Svanbergsson gsvanbergs@gmail.com
Table I, Table II, Table III, Table IV, Table V.
