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Spinal abnormalities matter less than we assume, but they still do matter

PainSci » bibliography » Brinjikji et al 2015
Tags: back pain, arthritis, neck, etiology, biomechanics, spine, aging, intervertebral disc, pain problems, head/neck, pro

Ten articles on PainSci cite Brinjikji 2015: 1. When to Worry About Low Back Pain2. The Trouble with Chairs3. (Almost) Never Use Ice on Low Back Pain!4. The Complete Guide to Low Back Pain5. The Complete Guide to Neck Pain & Cricks6. Are Orthotics Worth It?7. Healing Usually Accelerates8. Your Back Is Not Out of Alignment9. MRI and X-Ray Often Worse than Useless for Back Pain10. When to Worry About Neck Pain … and when not to!

PainSci notes on Brinjikji 2015:

Signs of degeneration are present in high percentages of healthy people with no symptoms. “Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.” And yet! See the authors’ other paper, in a later issue of the journal (Brinjikji), importantly concludes the “opposite”: that degenerative features are nevertheless “more prevalent in adults 50 years of age or younger with back pain compared with asymptomatic individuals.”

In other words, abnormalities matter less than many patients and professionals still assume, but they still do matter.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND AND PURPOSE: Degenerative changes are commonly found in spine imaging but often occur in pain-free individuals as well as those with back pain. We sought to estimate the prevalence, by age, of common degenerative spine conditions by performing a systematic review studying the prevalence of spine degeneration on imaging in asymptomatic individuals.

MATERIALS AND METHODS: We performed a systematic review of articles reporting the prevalence of imaging findings (CT or MR imaging) in asymptomatic individuals from published English literature through April 2014. Two reviewers evaluated each manuscript. We selected age groupings by decade (20, 30, 40, 50, 60, 70, 80 years), determining age-specific prevalence estimates. For each imaging finding, we fit a generalized linear mixed-effects model for the age-specific prevalence estimate clustering in the study, adjusting for the midpoint of the reported age interval.

RESULTS: Thirty-three articles reporting imaging findings for 3110 asymptomatic individuals met our study inclusion criteria. The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age. The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age.

CONCLUSIONS: Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. These imaging findings must be interpreted in the context of the patient's clinical condition.

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