The Study: Prevalence of radiographic findings in individuals with chronic low back pain screened for a randomized controlled trial: secondary analysis and clinical implications.
- The authors looked at the following: disc degeneration, spondylolisthesis, transitional segmentation, and sacral slope.
- The subjects all had chronic low back pain and were aged from 21 to 65.
- The study included 247 subjects and they used x-rays of those subjects to obtain the information.
- The subjects had suffered from low back pain for 12 or more weeks.
- Transitional segments were seen in 14% of the cases.
- Disc degeneration was seen in 29% of the subjects at L1-2, 41% of the subjects at L2-3, 49% of the subjects at L3-4, 42% of the subjects at L4-5 and 37% of the subjects at L5-S1.
- 18% of the subjects had degenerative spondylolisthesis while only 5% had isthmic spondylolisthesis.
- The sacral slope was similar to the amounts reported in other populations.
- Although the subjects had to have suffered from low back pain for at least 12 weeks to be included in the study, 91% of the subjects had suffered from the low back pain for over a year.
Abnormal findings are quite common on radiographs in subjects having chronic low back pain.
There is a debate in our profession as to when and why imaging is needed in a patient's case. I think that this question is the one most likely to tear apart the fabric of chiropractic (see my article in the journal Chiropractic History Volume 33, No. 1 entitled History or Science: The Controversy over Chiropractic Spinography.) But whatever side of this issue that you support, you should be aware that there were a lot of patients in this study with chronic low back pain that had changes in their spine that could only be seen with imaging. Now you may have other reasons than just pathologies for obtaining radiographs, such as structural alignment, and you have to decide what findings will prompt you to obtain an x-ray. But no matter how you decide to obtain imaging in a patient's case you should be aware of studies such as this. Like Fox news "we report, you decide".
Reviewer: Roger Coleman DC
Editor's Comments: The authors only looked for four types of findings; disc degeneration, spondylolisthesis, transitional segments, and sacral slope. Despite the very limited nature of their inquiry, 59% of these subjects exhibited at least one positive finding...what seems to me to be a very high number. Of course in a real world scenario, many other types of information could have also been gleaned from the films; various other pathologies, fractures, developmental anomalies, and last but certainly not least, valuable insight as to the patient's biomechanical status. Doctors who are sitting the fence as chiropractic goes through its internal debate regarding the need (or lack thereof) for spinal radiographs might want to keep the results of this study in mind before allowing their scope of practice to be infringed upon any further.
Editor: Mark R. Payne DC
Reference: Vining RD, Potocki E, McLean I, Seidman M, Morgenthal AP, Boysen J, Goetz C. Prevalence of radiographic findings in individuals with chronic low back pain screened for a randomized controlled trial: secondary analysis and clinical implications. J Manipulative Physiol Ther. 2014;37:678-87
Link to Abstract: http://www.ncbi.nlm.nih.gov/pubmed/25455834
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