Abstract
Purpose
By systematic literature review, to quantify the association between vertebral endplate signal changes (VESC) and non-specific low back pain (NSLBP).
Materials and methods
MEDLINE, EMBASE, and SveMED databases were searched for the period 1984 to June 2009. Articles were included which investigated the association between VESC and NSLBP and reported sufficient data to construct two-by-two tables. Articles on specific low back pain conditions were excluded. A standardised data collection and quality assessment were performed. To estimate the association between VESC and NSLBP, two-by-two tables were created and exact odds ratios were calculated with 95% confidence intervals (CI). Meta-analysis was performed on homogeneous studies.
Results
Fourteen articles met the inclusion criteria. A statistically significant positive association between VESC and NSLBP was found in 10 of 14 studies from the general, working, and clinical populations with odds ratios ranging from 2.0 to 27.9. Two of the other four studies showed positive associations, one study a neutral association and the other a negative association but all these results were not statistically significant. Meta-analysis of the eight discography studies included in the review showed a pooled odds ratio between VESC and pain on discography of 4.50 (CI 1.96-10.32). The median prevalence of pain on discography was 88.8% in people with VESC and 41.6% in those without VESC (46.8% overall).
Conclusions
The results from this systematic review show that VESC in the lumbar spine is associated with pain and therefore should be noted routinely in MRI reports.
Conflicts of interest: None
Sources of funding: The study was funded by the Fund for Chiropractic Research and Postgraduate Education.
