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Low back pain: a radiographic enigma.

R B Phillips, J W Frymoyer, B V Mac Pherson

    Journal of Manipulative and Physiological Therapeutics
    |September 1, 1986
    PubMed
    Summary

    Spinal radiographs have minimal value in predicting low back pain. Chiropractor and radiologist assessments showed poor reliability for most variables, with few reliable predictors of back or leg complaints.

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    Area of Science:

    • Radiology
    • Orthopedics
    • Chiropractic

    Background:

    • Low back pain is a prevalent condition with various contributing factors.
    • Spinal radiographs are commonly used in the assessment of low back pain.
    • The reliability of radiographic interpretations by chiropractors and radiologists is crucial for accurate diagnosis.

    Purpose of the Study:

    • To assess the interobserver reliability of chiropractors and a radiologist in analyzing lumbar spine radiographs.
    • To determine the predictive value of radiographic variables for low back complaints.
    • To evaluate the utility of spinal radiographs in epidemiological studies of low back pain.

    Main Methods:

    • Ninety-nine lumbar spine radiographs from males aged 18-55 were analyzed.
    • Three chiropractors and one radiologist independently assessed 56 radiographic variables.
    • Interobserver reliability was calculated for all variables.

    Main Results:

    • Six of 56 variables showed high interobserver reliability, primarily objective measurements.
    • Sixteen additional variables demonstrated fair interobserver reliability.
    • Poor interobserver reliability was observed between chiropractors and the radiologist for most variables, except for disc space height at L3-4 and L4-5.

    Conclusions:

    • Spinal radiographs have minimal value in predicting the presence or absence of low back complaints.
    • Radiographic variables, including those assessed by chiropractors and radiologists, are not reliable predictors of low back pain.
    • Spinal radiographs have no value in epidemiological studies of low back pain due to poor reliability.

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