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Symptomatic and asymptomatic abnormalities in patients with lumbosacral radicular syndrome: Clinical examination compared with MRI

PainSci » bibliography » van Rijn et al 2006
Tags: spine, back pain, counter-intuitive, pain problems

PainSci commentary on van Rijn 2006: ?This page is one of thousands in the 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 wherever possible.

There’s a substantial body of evidence showing that back pain and sciatica symptoms correlate only loosely with signs of intervertebral disk trouble identified by MRI. This study shows the same thing in an interesting new way: there’s also a poor left-right correlation between symptoms and herniations. In 57 patients with one-sided symptoms, MRI showed abnormalities on the same side in most cases (74%), but certainly not all. A full third of patients also had some kind of abnormality on the painless side, and about quarter of those were clear nerve root compressions.

This data explains something many healthcare professionals have seen: patients with a disc herniation on the “wrong” side for their symptoms.

~ Paul Ingraham

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.

OBJECTIVE: To determine the frequency of symptomatic and asymptomatic herniated discs and root compression in patients with lumbosacral radicular syndrome (LRS) and to correlate clinical localization with MRI findings.

METHODS: Fifty-seven patients with unilateral LRS were included in the study. Using the visual analogue scale, two physicians independently localized the most likely lumbar level of complaints. These clinical predictions of localizations were correlated with the MRI findings.

RESULTS: MRI showed abnormalities on the symptomatic side in 42 of 57 patients (74%). In 30% of the patients, MRI confirmed an abnormality at the exact same level as determined after clinical examination. On the asymptomatic side, MRI showed abnormalities in 19 of 57 patients (33%), 13 (23%) of these patients had asymptomatic root compression.

CONCLUSIONS: In more than two-thirds of the patients with unilateral LRS there was no exact match between the level predicted by clinical examination and MRI findings. These discrepancies complicate the decision whether or not to operate.

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