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1467. Associations of Back Symptoms with Lumbar Spine MRI
Authors * Denotes Presenting Author
Azar Dagher *;
Univ. Of MD School of Medicine
The subjectivity of low back symptoms for lumbar spine pathology is a given for care-takers, both for the presence and type of pathology. There are few studies that attempt to link the type of symptom with the pathology. Studies document the subjective nature of symptoms and results widely vary .
Provocative lumbar discography has a legacy of lumbar spine evaluation for the surgeon before the era of MRI with lingering use [6-13]. The procedure can identify the levels that are clinically relevant. A large data base [12 includes presenting clinical symptoms never before previously published before this work. With this data the author proposes that if an analysis was narrowed in scope to include only those patients with one level of positive provocative discography, then presenting symptoms that are relevant for MRI pathology could be tested for significance by limiting an analysis to only the MRI findings at that level.
Materials and Methods:
The large Health Insurance Privacy And Portability Act-compliant retrospective database of lumbar MRI with discography (736 patients) has been previously described in detail in several prior publications . Degenerative disc, disc bulge, annular tear, or disc herniation, and Modic 1 or 2 endplate findings on MRI were identified for that level only along with presenting symptoms of ache, stab, burning, and paresthesias from the clinical questionnaire. Sensitivity, specificity, positive predictive value (PV+), and negative predictive value (PV-) of symptoms were calculated with a p value < 0.1 used for significance.
The following symptom/MRI pairs are associated: ache and herniation (p= 0.063, sensitivity = 0.89, specificity = 0.18, PV+ = 0.40, PV- =0.73), stab and degeneration (p= 0.092, sensitivity = 0.81, specificity = 0.29, PV+ = 0.20, PV- =0.88), stab and Modic 2 (p= 0.067, sensitivity = 0.61, specificity = 0.26, PV+ = 0.09, PV- =0.85), burning and bulge (p= 0.024, sensitivity = 0.23, specificity = 0.60, PV+ = 0.08, PV- =0.85), and burning and annular tears (p= 0.078, sensitivity = 0.45, specificity = 0.65, PV+ = 0.32, PV- =0.76).
What have been previously characterized as non-specific low back symptoms appear to have some relevancy with MRI findings: ache with disc herniations, stab with disc degeneration, stab with Modic 2 changes, burning with disc bulge, and burning with annular tears.