Related Experiment Video
Updated: Jul 19, 2026
Motor Imagery Brain-Computer Interface in Rehabilitation of Upper Limb Motor Dysfunction After Stroke
Published on: September 1, 2023
Are first-time episodes of serious LBP associated with new MRI findings?
Eugene Carragee1, Todd Alamin, Ivan Cheng
1Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Rm. R-171, Stanford, CA 94305, USA. carragee@stanford.edu
Background:
Magnetic resonance (MR) imaging is frequently used to evaluate first-time episodes of serious low back pain (LBP). Common degenerative findings are often interpreted as recent developments and the probable anatomic cause of the new symptoms. To date no prospective study has established a baseline MR status of the lumbar spine in subjects without significant LBP problems and prospectively surveyed these subjects for acute changes shortly after new and serious LBP episodes. This method can identify new versus old MR findings possibly associated with the acute symptomatic episode.
Purpose:
To determine if new and serious episodes of LBP are associated with new and relevant findings on MRI.
Study Design:
Prospective observational study with baseline and post-LBP MRI monitoring of 200 subjects over 5 years.
Outcome Measures:
Clinical outcomes: LBP intensity (visual analogue scale), Oswestry Disability Index, and work loss. MRI outcomes: disc degeneration, herniation, annular fissures, end plate changes, facet arthrosis, canal stenosis, spondylolisthesis, and root impingement.
Methods:
200 subjects with a lifetime history of no significant LBP problems, and a high risk for new LBP episodes were studied at baseline with physical examination, plain radiographs, and MR imaging. Subjects were followed every 6 months for 5 years with a detailed telephone interview. Subjects with a new severe LBP episode (LBP>or=6/10,>1 week) were assessed for new diagnostic tests. New MR imaging, taken within 6 to 12 weeks of the start of a new LBP episode, was compared with baseline (asymptomatic) images. Two independent and blinded readers evaluated each baseline and follow-up study.
Results:
During the 5-year observation period of 200 subjects, 51 (25%) subjects were evaluated with a lumbar MRI for clinically serious LBP episodes, and 3/51 (6%) had a primary radicular complaint. These 51 subjects had 67 MR scans. Of 51 subjects, 43 (84%) had either unchanged MR or showed regression of baseline changes. The most common progressive findings were disc signal loss (10%), progressive facet arthrosis (10%), or increased end plate changes (4%). Only two subjects, both with primary radicular complaints, had new findings of probable clinical significance (4%). Subjects having another MR were more likely to have had chronic pain at baseline (odds ratio [OR]=3.19; 95% confidence interval [CI] 1.61-6.32), to smoke (OR=5.81; 95% CI 1.99-16.45), have baseline psychological distress (OR 2.27; 95% CI 1.15-4.49), and have previous disputed compensation claims (OR=2.35; 95% CI 0.97-5.69). Subjects involved in current compensation claims were also more likely to have an MR scan to evaluate the LBP episode (risk ratio=4.75, p<.001), but were unlikely to have significant new findings. New findings were not more frequent in subjects with LBP episodes developing after minor trauma than when LBP developed spontaneously.
Conclusion:
Findings on MR imaging within 12 weeks of serious LBP inception are highly unlikely to represent any new structural change. Most new changes (loss of disc signal, facet arthrosis, and end plate signal changes) represent progressive age changes not associated with acute events. Primary radicular syndromes may have new root compression findings associated with root irritation.
Insights
New MRI findings are unlikely to be linked to serious low back pain (LBP) episodes. Most changes observed are age-related, not acute developments, except for primary radicular syndromes.
Area of Science:
- Radiology
- Orthopedics
- Spine Surgery
Background:
- Magnetic resonance (MR) imaging is commonly used for first-time serious low back pain (LBP) episodes.
- Degenerative findings on MR imaging are often misattributed as recent developments causing LBP.
- No prior prospective studies have established baseline MR status in asymptomatic individuals to track acute changes post-LBP.
Purpose of the Study:
- To investigate the association between new, serious episodes of LBP and new, relevant findings on lumbar spine MR imaging.
Main Methods:
- A 5-year prospective observational study involving 200 subjects with no prior significant LBP.
- Baseline MR imaging and clinical assessments were performed, followed by 6-month check-ins.
- Subjects experiencing severe LBP underwent repeat MR imaging within 6-12 weeks for comparison with baseline.
Main Results:
- Of 51 subjects with serious LBP episodes, 84% showed unchanged or regressed MR findings.
- New findings of probable clinical significance were rare (4%), primarily in subjects with radicular complaints.
- Factors associated with repeat MR scans included chronic pain, smoking, psychological distress, and compensation claims, but not new findings.
Conclusions:
- MR imaging findings within 12 weeks of serious LBP onset are unlikely to reflect new structural changes.
- Most observed changes, such as disc signal loss and facet arthrosis, represent age-related progression.
- New root compression findings may be associated with primary radicular syndromes.
