Clinical prevalence and population incidence of serious pathologies among patients undergoing magnetic resonance imaging for low back pain.

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dc.contributor.author Street, Katy J en
dc.contributor.author White, Steven G en
dc.contributor.author Vandal, Alain en
dc.date.accessioned 2020-01-12T20:53:15Z en
dc.date.issued 2019-09-10 en
dc.identifier.citation Spine Journal. 20 (1), 101-111. Jan 2020 en
dc.identifier.issn 1529-9430 en
dc.identifier.uri http://hdl.handle.net/2292/49501 en
dc.description.abstract BACKGROUND:In rare cases low back pain may be caused by underlying serious pathology such as fracture, malignancy, cauda equina syndrome, or spinal infection. The lack of evidence regarding either the clinical prevalence or population incidence of serious pathologies in the lumbar spine makes it difficult for clinicians to adequately assess a patient's risk of serious pathology. PURPOSE:To determine the prevalence of serious pathologies in patients with low back pain who have been referred for a lumbar magnetic resonance imaging (MRI) by a specialist in a private secondary care or public tertiary care setting. The incidence of these serious pathologies in the geographic region of South Auckland, New Zealand was also investigated. STUDY DESIGN:Retrospective, observational cohort study. PATIENT SAMPLE:Consecutive patients referred for lumbar MRI over a 10-month period (1st of October 2013-31st of July 2014). METHOD:Data from all eligible MRI reports was analyzed and any serious pathologies were identified and recorded. Prevalence (along with 95% confidence intervals) was calculated as a percentage of the study population. Prevalence specific to private secondary care and public tertiary care settings was also calculated and prevalence rate ratios were determined to allow comparison between settings. Incidence in the geographic region of South Auckland, New Zealand, was determined using data collected from participants recruited from the regional public hospital. Population incidence with respect to age, gender, and ethnicity for each target condition was calculated and incidence rate ratios were computed to compare groups. RESULTS:A total of 2,383 participants referred for lumbar MRI scans were included in this study. Prevalence was significantly higher in the public tertiary care setting than in the private secondary care setting for all pathologies investigated in this study. Pathology specific prevalence in secondary care vs tertiary care settings was: malignancy, 0.3%, 4.4% (p<.001); fracture 2.2%, 6.7% (p<.001); cauda equina compression 0.6%, 2.3% (p=.001); infection 0.1%, 3.4% (p<.001). The combined prevalence in secondary care was 3.2% and in tertiary care 14.8% (p<.001). Pathology specific total incidence was: fracture, 13 per 100,000 person-years (p-y); malignancy 8.5 per 100,000 p-y; cauda equina compression 4.4 per 100,000 p-y; spinal infection 6.6 per 100,000 p-y. CONCLUSIONS:The prevalence of serious pathologies was significantly higher in tertiary care (public health) than in private secondary care settings. One in every 6.5 patients referred for MRI in tertiary care demonstrated structural abnormalities associated with serious pathology, which raises the question of whether access to MRI should be re-evaluated. en
dc.format.medium Print-Electronic en
dc.language eng en
dc.relation.ispartofseries The spine journal : official journal of the North American Spine Society en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.rights.uri https://www.elsevier.com/about/open-science/open-access en
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/ en
dc.title Clinical prevalence and population incidence of serious pathologies among patients undergoing magnetic resonance imaging for low back pain. en
dc.type Journal Article en
dc.identifier.doi 10.1016/j.spinee.2019.09.002 en
dc.rights.holder Copyright: The author en
pubs.publication-status Published en
dc.rights.accessrights http://purl.org/eprint/accessRights/OpenAccess en
pubs.subtype Journal Article en
pubs.elements-id 784478 en
pubs.org-id Science en
pubs.org-id Statistics en
dc.identifier.eissn 1878-1632 en
pubs.record-created-at-source-date 2019-09-14 en
pubs.dimensions-id 31518682 en


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