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Does MRI Grading Help Us Understand Pain in Spinal Stenosis?


MRI images of the lumbar spine

We have a plethora of studies showing pathologic findings on MRI are poor indicators of why someone has pain. These include herniations, osteoarthritis, and ligament and tendon tears. Let's make sure stenosis isn't left off of the list.


This study included 293 patients who were evaluated by orthopedic spine surgeons who were certified specialists. Inclusion criteria were 1) > 50 years of age; (2) the presence of neurogenic intermittent claudication and pain and/or numbness in the lower extremities with or without LBP; (3) lumbar spinal stenosis confirmed by MRI; and (4) a referral to physical therapy. The radiographic findings were compared to a subjective report of pain and function. The stenosis grading was not associated with the severity of back, buttock, or leg pain. Endplate changes were weakly correlated with low back pain.


In the multivariate regression analysis, age, female sex, trunk muscle mass, diabetes, NRS buttock, and leg pain, NRS buttock and leg numbness, SF-36 vitality, pelvic tilt, and the total number of endplate defects were associated with the severity of LBP...but stenosis was not. This single study will not change the narrative painted by physicians. Waving this study in front of a patient will not change their concerns about stenosis either. It can potentially provide an opening for a conversation and provide you with a more accurate assessment of the patient's prognosis.

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