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Associations Between Sum Scores or Combinations of MRI Findings in the Lumbar Spine and Low Back Pain-Related Outcomes: A Systematic Review
Dragsbæk et al. European Journal of Pain. July 2025
ABSTRACT - We identified 11,537 studies and included 49 with 37 different study populations. Twelve studies had low RoB. Thirty one studies investigated sum scores of one specific MRI finding. Ten out of 16 studies investigating disc degeneration, two out of three investigating herniation and seven out of 10 investigating endplate-related changes reported stronger associations between increasing sum scores and LBP. Additionally, seven of nine studies reported the same for disc degeneration and LBP-related disability. Sixteen studies investigated a sum score of different MRI findings. Eight of 11 studies reported stronger associations between increasing findings and LBP, and five of eight found the same for LBP-related disability.
EDITOR'S COMMENT - This research provides further strong evidence that counters the view that "there is no association between back pain and MRI changes." The biological component of low back pain is often ignored in discussions on the topic, which is due to ideology rather than scientific justification. This study also has implications on trying to pin down a single pain-generator. This is especially relevant in elderly with low back pain, where it is likely there are multiple pain generators in many individuals.
