Low back pain (LBP) with and without radiculopathy is a poorly defined condition resulting from an interplay of biologic and nonbiologic factors. There is uncertainty regarding its natural history as well as the meaningfulness of many clinical findings. Lumbar magnetic resonance imaging (MRI) is frequently employed in the diagnostic work-up of patients with acute LBP. While this technology provides a high yield relative to detection of morphologic variation within the lumbar spine and associated tissues, the predictive validity of most of these findings remains uncertain. Recent reports have described a high prevalence of morphologic variation in asymptomatic people as well as low correlations between lumbar intervertebral disc impairment and symptom distribution. Thus, in the absence of clinical findings suggestive of serious disease uncertainty exists relative to the diagnostic usefulness and cost- effectiveness of lumbar MRI especially when used in individuals with a recent onset of symptoms. Specific concerns relate to the identification of findings which may guide treatment decision making as well as the role of a patient's awareness of his or her MRI findings in long-term outcome. Because of this, and considering the high cost of this procedure, there is a strong need to investigate the diagnostic efficacy of lumbar MRI's role in the management of patients with LBP and/or radiculopathy. The investigators are proposing a prospective, longitudinal, randomized study which correlates repeated lumbar MRI findings with a series of patient reports and examination findings on large group of people with LBP and/or radiculopathy.
The specific aims of this study are to: 1. document the natural morphologic history of LBP in people with and lower extremity radiculopathy, 2. identify morphologic characteristics of prognostic value, 3. measure the value of diagnostic information per se and 4. estimate the cost- effectiveness of early imaging. The investigators are hypothesizing that findings from lumbar MRI do not predict outcome and that indications for management are clinically based. In addition the authors are hypothesizing that any reduction in anxiety or reassurance associated with knowledge of MRI findings is not cost- effective.
| Ash, L M; Modic, M T; Obuchowski, N A et al. (2008) Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR Am J Neuroradiol 29:1098-103 |
| Modic, Michael T; Obuchowski, Nancy A; Ross, Jeffrey S et al. (2005) Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiology 237:597-604 |
