Ten articles on PainSci cite Brinjikji 2015: 1. When to Worry About Low Back Pain 2. The Trouble with Chairs 3. (Almost) Never Use Ice on Low Back Pain! 4. The Complete Guide to Low Back Pain 5. The Complete Guide to Neck Pain & Cricks 6. Are Orthotics Worth It? 7. Healing Usually Accelerates 8. Your Back Is Not Out of Alignment 9. MRI and X-Ray Often Worse than Useless for Back Pain 10. 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.
- “The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects,” DG Borenstein, SD Boden JW O’Mara, and others, Journal of Bone & Joint Surgery (American), 2001.
- “Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors,” Jeffrey G Jarvik, William Hollingworth, Patrick J Heagerty, David R Haynor, Edward J Boyko, and Richard A Deyo, Spine (Phila Pa 1976), 2005.
- “Prospective controlled study of the development of lower back pain in previously asymptomatic subjects undergoing experimental discography,” Eugene J Carragee, Babak Barcohana, Todd Alamin, and Erica van den Haak, Spine (Phila Pa 1976), 2004.
- “The Twin Spine Study: contributions to a changing view of disc degeneration,” Michele C Battié, Tapio Videman, Jaakko Kaprio, Laura E Gibbons, Kevin Gill, Hannu Manninen, Janna Saarela, and Leena Peltonen, Spine J, 2009.
- “MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis,” W Brinjikji, F E Diehn, J G Jarvik, C M Carr, D F Kallmes, M H Murad, and P H Luetmer, AJNR Am J Neuroradiol, 2015.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.
- Sudden amnesia resulting in pain relief: the relationship between memory and pain. Choi 2007 Pain.
- Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial. Guimarães 2021 Pain.