Degenerative Magnetic Resonance Imaging Changes in Patients With Chronic Low Back Pain A Systematic Review
Degenerative Magnetic Resonance Imaging Changes in Patients With Chronic Low Back Pain A Systematic Review
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DOI：
10.1097/brs.0b013e31822ef700
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发表时间：
2011-10-01
期刊：
影响因子：
3
通讯作者：
Skelly, Andrea C.
中科院分区：
文献类型：
--
作者：
Chou, Dean;Samartzis, Dino;Skelly, Andrea C.
设计。系统性综述：客观。系统地寻找、评价和总结以下研究：(1)评价退行性核磁共振成像(MRI)改变与慢性下腰痛(CLBP)的关系；(2)比较这些退行性MRI改变的手术和非手术治疗。常规MRI在CLBP患者中的作用尚不清楚。对退行性MRI改变的外科治疗是否能缓解背痛也是不确定的。在PubMed上对截至2011年3月1日发表的研究进行了系统的文献搜索。为了评估MRI退行性改变是否与CLBP相关，我们寻找了一些研究，旨在比较患有和不患有CLBP的受试者中MRI改变的患病率。患病率优势比被用来比较患有CLBP的受试者和未患CLBP的受试者中出现退行性MRI发现的几率。为了评估与非手术治疗相比，退行性MRI改变的手术治疗是否与不同的结果相关，我们进行了对比研究。采用分级系统来描述证据的整体强度。关于MRI和CLBP上退行性改变的关系，纳入了五项研究，所有研究都是横断面设计。在这些研究的基础上，除了一项研究外，所有研究中都发现了与腰椎间盘退变和CLBP有关的统计学意义上的相关性(优势比范围：1.8-2.8)。然而，跨研究的证据的总体强度被认为是不够的。未发现退行性MRI改变的手术和非手术治疗的对比研究。尽管退行性MRI改变与CLBP之间可能存在联系，但考虑到纳入研究的质量、退行性MRI改变与CLBP之间缺乏直接联系以及研究的异质性，目前尚不清楚这些估计是否准确地代表了这种联系。因此，强烈建议不要常规使用MRI来评估CLBP。由于没有数据评估退行性MRI改变的手术治疗效果，强烈建议不要仅基于退行性MRI改变而手术治疗CLBP。临床建议。建议1：没有足够的证据支持在慢性阻塞性肺疾病患者中常规使用MRI。建议：强烈建议2：不推荐仅基于退行性改变MRI表现的CLBP的外科治疗。推荐：Strong
Design. Systematic review.Objective. To systematically search for critically appraise and summarize studies that (1) evaluated the association between degenerative magnetic resonance imaging (MRI) changes and chronic low back pain (CLBP) and (2) compared surgical and nonsurgical treatment of these degenerative MRI changes.Summary of Background Data. The role of routine MRI in patients with CLBP is unclear. It is also uncertain whether or not surgical treatment of degenerative MRI changes results in alleviation of back pain.Methods. Systematic literature searches were conducted in PubMed for studies published through March 1, 2011. To evaluate whether MRI degenerative changes are associated with CLBP, studies that were designed to compare the prevalence of MRI changes among subjects with and without CLBP were sought. The prevalence odds ratio was used to compare the odds of degenerative MRI findings in subjects with CLBP to the odds of such findings among those without CLBP. To evaluate whether surgical treatment of degenerative MRI changes is associated with different outcomes compared with nonsurgical treatment, comparative studies were sought. The GRADE system as applied to describe the strength of the overall body of evidence.Results. Regarding the association of degenerative changes on MRI and CLBP, five studies were included, all of which were cross-sectional in design. On the basis of these studies, a statistically significant association was found in all but one study regarding the presence of disc degeneration and CLBP (odds ratio range: 1.8-2.8). The overall strength of evidence across studies was considered to be insufficient, however. No comparative studies of surgical versus nonsurgical treatment of degenerative MRI changes were identified.Conclusion. Although there may be an association between degenerative MRI changes and CLBP, it is unknown if these estimates accurately represent the association given the quality of included studies, lack of a direct link between degenerative MRI changes and CLBP, and heterogeneity across studies. Thus, a strong recommendation against the routine use of MRI for CLBP evaluation is made. Since there are no data evaluating the efficacy of the surgical treatment of degenerative MRI changes, a strong recommendation is made against the surgical treatment of CLBP based solely upon degenerative MRI changes.Clinical Recommendations. Recommendation 1: There is insufficient evidence to support the routine use of MRI in patients with CLBP. Recommendation: Strong Recommendation 2: Surgical treatment of CLBP based exclusively on MRI findings of degenerative changes is not recommended. Recommendation: Strong