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Journal ArticleDOI

Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation

01 Mar 1990-Journal of Bone and Joint Surgery, American Volume (J Bone Joint Surg Am)-Vol. 72, Iss: 8, pp 403-408
TL;DR: In this paper, the authors performed magnetic resonance imaging on sixty-seven individuals who had never had low-back pain, sciatica, or neurogenic claudication, and found that about one-third of the subjects were found to have a substantial abnormality.
Abstract: We performed magnetic resonance imaging on sixty-seven individuals who had never had low-back pain, sciatica, or neurogenic claudication. The scans were interpreted independently by three neuro-radiologists who had no knowledge about the presence or absence of clinical symptoms in the subjects. About one-third of the subjects were found to have a substantial abnormality. Of those who were less than sixty years old, 20 per cent had a herniated nucleus pulposus and one had spinal stenosis. In the group that was sixty years old or older, the findings were abnormal on about 57 per cent of the scans: 36 per cent of the subjects had a herniated nucleus pulposus and 21 per cent had spinal stenosis. There was degeneration or bulging of a disc at at least one lumbar level in 35 per cent of the subjects between twenty and thirty-nine years old and in all but one of the sixty to eighty-year-old subjects. In view of these findings in asymptomatic subjects, we concluded that abnormalities on magnetic resonance images must be strictly correlated with age and any clinical signs and symptoms before operative treatment is contemplated.
Citations
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Journal ArticleDOI
TL;DR: This report provides the best available prevalence estimates for the US for osteoarthritis, polymyalgia rheumatica, gout, fibromyalgia, and carpal tunnel syndrome as well as the symptoms of neck and back pain.
Abstract: Objective To provide a single source for the best available estimates of the US prevalence of and number of individuals affected by osteoarthritis, polymyalgia rheumatica and giant cell arteritis, gout, fibromyalgia, and carpal tunnel syndrome, as well as the symptoms of neck and back pain. A companion article (part I) addresses additional conditions.

4,813 citations

22 Jan 2008
TL;DR: In this paper, the best available estimates of the US prevalence of and number of individuals affected by osteoarthritis, polymyalgia rheumatica and giant cell arteritis, gout, fibromyalgia, and carpal tunnel syndrome, as well as the symptoms of neck and back pain are provided.
Abstract: OBJECTIVE To provide a single source for the best available estimates of the US prevalence of and number of individuals affected by osteoarthritis, polymyalgia rheumatica and giant cell arteritis, gout, fibromyalgia, and carpal tunnel syndrome, as well as the symptoms of neck and back pain. A companion article (part I) addresses additional conditions. METHODS The National Arthritis Data Workgroup reviewed published analyses from available national surveys, such as the National Health and Nutrition Examination Survey and the National Health Interview Survey. Because data based on national population samples are unavailable for most specific rheumatic conditions, we derived estimates from published studies of smaller, defined populations. For specific conditions, the best available prevalence estimates were applied to the corresponding 2005 US population estimates from the Census Bureau, to estimate the number affected with each condition. RESULTS We estimated that among US adults, nearly 27 million have clinical osteoarthritis (up from the estimate of 21 million for 1995), 711,000 have polymyalgia rheumatica, 228,000 have giant cell arteritis, up to 3.0 million have had self-reported gout in the past year (up from the estimate of 2.1 million for 1995), 5.0 million have fibromyalgia, 4-10 million have carpal tunnel syndrome, 59 million have had low back pain in the past 3 months, and 30.1 million have had neck pain in the past 3 months. CONCLUSION Estimates for many specific rheumatic conditions rely on a few, small studies of uncertain generalizability to the US population. This report provides the best available prevalence estimates for the US, but for most specific conditions more studies generalizable to the US or addressing understudied populations are needed.

4,355 citations

Journal ArticleDOI
04 Jan 1995-JAMA
TL;DR: This model proposes a taxonomy or classification scheme for different measures of health outcome, dividing these outcomes into five levels: biological and physiological factors, symptoms, functioning, general health perceptions, and overall quality of life.
Abstract: HEALTH-related quality of life (HRQL) is increasingly used as an outcome in clinical trials, effectiveness research, and research on quality of care. Factors that have facilitated this increased usage include the accumulating evidence that measures of HRQL are valid and "reliable,"1the publication of several large clinical trials showing that these outcome measures are responsive to important clinical changes,2-5and the successful development and testing of shorter instruments that are easier to understand and administer.6-13Because these measures describe or characterize what the patient has experienced as the result of medical care, they are useful and important supplements to traditional physiological or biological measures of health status. Given this improved ability to assess patients' health status, how can physicians and health care systems intervene to improve HRQL? Implicit in the use of measures of HRQL in clinical trials and in effectiveness research is the concept that clinical

3,558 citations

Journal ArticleDOI
TL;DR: All three pain-rating scales are valid, reliable and appropriate for use in clinical practice, although the Visual Analogue Scale has more practical difficulties than the Verbal Rating Scale or the Numerical Rating Scale.
Abstract: Aims and objectives. This review aims to explore the research available relating to three commonly used pain rating scales, the Visual Analogue Scale, the Verbal Rating Scale and the Numerical Rating Scale. The review provides information needed to understand the main properties of the scales. Background. Data generated from pain-rating scales can be easily misunderstood. This review can help clinicians to understand the main features of these tools and thus use them effectively. Method. A MedLine review via PubMed was carried out with no restriction of age of papers retrieved. Papers were examined for methodological soundness before being included. The search terms initially included pain rating scales, pain measurement, Visual Analogue Scale, VAS, Verbal Rating Scale, VRS, Numerical/numeric Rating Scale, NRS. The reference lists of retrieved articles were used to generate more papers and search terms. Only English Language papers were examined. Conclusions. All three pain-rating scales are valid, reliable and appropriate for use in clinical practice, although the Visual Analogue Scale has more practical difficulties than the Verbal Rating Scale or the Numerical Rating Scale. For general purposes the Numerical Rating Scale has good sensitivity and generates data that can be statistically analysed for audit purposes. Patients who seek a sensitive pain-rating scale would probably choose this one. For simplicity patients prefer the Verbal Rating Scale, but it lacks sensitivity and the data it produces can be misunderstood. Relevance to clinical practice. In order to use pain-rating scales well clinicians need to appreciate the potential for error within the tools, and the potential they have to provide the required information. Interpretation of the data from a pain-rating scale is not as straightforward as it might first appear.

2,337 citations

References
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Journal ArticleDOI
TL;DR: Low back pain is usually a self-limiting symptom, but it costs at least $16 billion each year and disables 5.4 million Americans, and the fact that a benign physical condition has such an importa...
Abstract: LOW back pain is usually a self-limiting symptom, but it costs at least $16 billion each year1 , 2 and disables 5.4 million Americans.3 The fact that a benign physical condition has such an importa...

1,092 citations

Journal ArticleDOI
01 Sep 1984-Spine
TL;DR: To study the type and number of CAT scan abnormalities of the lumbar spine that occur in asymptomatic people, 52 studies from a control population with no history of back trouble were mixed randomly with six scans from patients with surgically proven spinal disease, and all were interpreted by three neuroradiologists in a blinded fashion.
Abstract: In order to study the type and number of CAT scan abnormalities of the lumbar spine that occur in asymptomatic people, 52 studies from a control population with no history of back trouble were mixed randomly with six scans from patients with surgically proven spinal disease, and all were interpreted

710 citations

Journal ArticleDOI
TL;DR: The incidence of myelographic abnormalities in 300 patients who were studied by posterior fossa myelography to establish a diagnosis of acoustic tumor is reported, even though patients had no symptoms of cervical or lumbar nerve root compression at the time of the examination.
Abstract: I N THE evaluation of the patient with back, neck, arm, or leg pain, great reliance has been placed on the results of myelography. Occasionally, difficulties arise in the correlation of the results of this study with the clinical examination. The myelogram may be normal in the face of a clear-cut clinical syndrome, or defects in the positive contrast column may be found at levels other than those thought to be involved. Accordingly, more information has been needed relative to the incidence of myelographic abnormalities in the asymptomatic patient. This paper reports the incidence of myelographic abnormalities in 300 patients who were studied by posterior fossa myelography to establish a diagnosis of acoustic tumor. Myelograms of the spinal axis were obtained even though these patients had no symptoms of cervical or lumbar nerve root compression at the time of the examination.

322 citations

Journal ArticleDOI
TL;DR: It has not been established whether internal derangement of the lumbar disc is sufficiently symptom-producing to be a therapeutic objective, especially a surgical one, or whether it represetits anything more than an aging process, and the patterns of degeneration seen in 628 of 2,187 discs injected by the Cleveland group and 773 of 6,784 discs injections by Feinberg or 322 of 870 disc injected by Massie and Stevens may represent nothing more than normal patterns for the age
Abstract: Carl Hirsch of Sw-eden noted that symptoms from ruptured discs could be exacerbated by injection of normal saline directly into the affected disc, atsd he reported sixteen such cases in 1948. At his suggestion, Knut Lindblom, long iu search of a w-ay of studying lumbar discs by contrast roentgenography, injected diodrast directly into fifteets discs in thirteen patietsts and described the typical appeararsce of a normal disc and a ruptured one. In 1950, he reported on thirty-eight patients who had fifty-two lumbar discs similarly injected. He noted that fifty discs were more or less ruptured. In 1951, his series had extended to 150 cases, but no metstion was made of the ratio of normal to pathological discs. By 1962, Collis and Gardner claimed superiority for the method over lunsbar myelography in detection of lumbar-disc disease, and they published findings in 1,014 cases. The bibliographies of Fernstr#{246}m and Collis cover virtually all the pertinent material published prior to 1963. Fernstr#{246}m’s article tentatively and soberly coissidered discography from all angles. He was aware of certain weaktsesses in the method ; Collis was more enthusiastic about the procedure. Approximately six additional articles on lumbar discography have appeared in the English literature between 1960 and 1967 1,2,10,13,19,20 Most authors display enthusiasm for the method, not as a successor to myelography but as an adjunct in detection of discogenic disease. Some 6,18 claim that careful physical examination usually suffices for accurate diagnosis. But lumbar myelography as an adjunct is certainly useful at-sd reliable . Everyone realizes that myelography cannot reveal lesions of the nucleus pulposus where the prolapse is directed neither posteriorly nor posterolaterally; however, the need for surgical intervention for prolapse of a disc where neither the spinal cord nor any nerve root is compressed is not established. Such prolapses, whether through vertebral plates (Schmorl’s nodes) or in any other direction, may not produce more than temporary pain. It also has not been established whether internal derangement of the lumbar disc is sufficiently symptom-producing to be a therapeutic objective, especially a surgical one, or whether it represetits anything more than an aging process. Thus, the patterns of degeneration seen in 628 of 2,187 discs injected by the Cleveland group and 773 of 6,784 discs injected by Feinberg or 322 of 870 discs injected by Massie and Stevens may represent nothing more than normal patterns for the age groups studied. Massie and Stevens found by discography that 34 per cent of the fifty-two asymptomatic volunteers had pathological changes at the interspace betw-een the fifth lumbar and first sacral vertebrae and also noted 16 per cent pathological changes in a total of 137 lumbar discs in this volunteer group. Discography enthusiasts seem to believe that no disc which show-s an irregularity or leakage of dye can be normal. The question arises from whence came the concept that the human disc, cervical or lumbar, is competent to and w’ill retain injected material of any sort. Certainly, this is not true in the cervical area where discography in fifty asymptomatic volunteers, ages twenty-one to fifty, gave patterns of leakage in 93 per cent of 148 discs injected 12#{149}A similar study of lumbar discography is reported in this paper. * Department of Orthopaedic Surgery, Washington Utsiversity School of Mediciuse, 660 South Euclid Avenue, St. Louis, Missouri 63110.

271 citations

Journal ArticleDOI
TL;DR: The results of this study indicate that a technically adequate MR examination was equivalent to CT and myelography in the diagnosis of lumbar canal stenosis and herniated disk disease.
Abstract: Sixty patients with suspected lumbar herniated disk and/or canal stenosis were studied prospectively with surface coil MRI, CT, and/or myelography, and the results were compared with the surgically confirmed abnormality. Forty-eight patients had lumbar surgery at 62 levels. There were no negative explorations. Thirty-nine patients had a myelogram and CT. Thirty of the CTs were performed following the injection of metrizamide for myelography. Nine patients had a CT without intrathecal contrast material 1 to several days before the myelogram. Six patients had myelography only, and three patients had CT only. All studies were evaluated for the location and type of disease in a forced choice fashion. Independent of the surgically correlated levels, there was 86.8% agreement between the MR and CT studies in all patients at 151 levels and 87.2% agreement between MR and myelography at 218 levels. At the operative levels, there was 82.6% agreement between MR and surgical findings for both type and location of disease; 83% agreement between CT and surgical findings; and 71.8% agreement between myelography and surgical findings. There was 92.5% agreement when MR and CT were used jointly, and 89.4% agreement when CT and myelography were used jointly. The results of this study indicate that a technically adequate MR examination was equivalent to CT and myelography in the diagnosis of lumbar canal stenosis and herniated disk disease. CT and MR can be complementary studies, and surface coil MR can be viewed as an alternative to myelography.

226 citations