SPINAL RADIOGRAPHIC FINDINGS AND NONSPECIFIC LOW-BACK-PAIN - A SYSTEMATIC REVIEW OF OBSERVATIONAL STUDIES

Study Design. A systematic review of published observational studies. Objectives. To examine the causal relationship between radiographic fi ndings and nonspecific low back pain. Summary of Background Data. The causal relationship between radiographic findings and nonspecific low back pain still is controversial. Methods. Two reviewers independently scored the methodologic quality of all relevant, available studies us ing a standardized set of criteria. The association between radiograph ic findings and nonspecific low back pain was expressed as an odds rat io with a corresponding 95% confidence interval. Results. Degeneration , defined by the presence of disc space narrowing, osteophytes, and sc lerosis, turned out to be associated with nonspecific low back pain wa s expressed as an ratios ranging from 1.2 to 3.3. Spondylolysis and sp ondylolisthesis, spina bifida, transitional vertebrae, spondylosis, an d Scheuermann's disease did not appear to be associated with low back pain. The validity scores of the observational studies ranged from 0% to 91% of the maximum score. Only two studies used a prospective desig n, and most studies lacked control for confounding, an appropriate tes t for nonspecific low back pain, and blinded assessment of radiographs and low back pain status. Conclusions. There is no firm evidence for the presence or absence of a causal relationship between radiographic findings and nonspecific low back pain.