PainSci summary of Brinjikji 2015?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★★☆?4-star ratings are for bigger/better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
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.
- “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.
- “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.
These ten articles on PainScience.com cite Brinjikji 2015 as a source:
- PS When to Worry About Low Back Pain — And when not to! What’s bark and what’s bite?
- PS The Trouble with Chairs — The science of being sedentary and how much it does (or doesn’t) affect your health and back pain
- PS (Almost) Never Use Ice on Low Back Pain! — An important exception to conventional wisdom about icing and heating
- PS Save Yourself from Low Back Pain! — Low back pain myths debunked and all your treatment options reviewed
- PS Save Yourself from Neck Pain! — A complete guide to chronic neck pain and the disturbing sensation of a “crick”
- PS Are Orthotics Worth It? — A consumer’s guide to the science and controversies of orthotics, special shoes, and other allegedly corrective foot devices
- PS Healing Usually Accelerates — The better you get, the faster you get better, a “delicious cycle” — but what if it doesn’t?
- PS Your Back Is Not Out of Alignment — Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain
- PS MRI and X-Ray Often Worse than Useless for Back Pain — Medical guidelines “strongly” discourage the use of MRI and X-ray in diagnosing low back pain, because they produce so many false alarms
- PS When to Worry About Neck Pain … and when not to! — Tips, checklists, and non-scary possible explanations for neck pain
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:
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.
- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige 2017 JAMA.