• Jani Takatalo, Jaro Karppinen, Jaakko Niinimäki, Simo Taimela, Pertti Mutanen, Roberto Blanco Sequeiros, Simo Näyhä, Marjo-Riitta Järvelin, Eero Kyllönen, and Osmo Tervonen.
• Institute of Clinical Medicine, University of Oulu, Oulu, Finland. janitaka@mail.student.oulu.fi
• Spine. 2012 Jun 15;37(14):1231-9.

Study DesignA cross-sectional magnetic resonance imaging (MRI) study.ObjectiveWe investigated the association among Modic changes, Schmorl's nodes, spondylolytic defects, high-intensity zone lesions, radial tears, herniations, and low back symptom severity.Summary Of Background DataDisc degeneration is associated with low back pain in early adulthood, but the associations between other MRI findings and low back pain are not well known.MethodsQuestionnaire data and MRI scans (1.5-T) were available for 554 subjects derived from a birth cohort at 21 years of age. Data on low back pain and back-related functional limitations at 18, 19, and 21 years of age were used for clustering of subjects, using latent class analysis. We used logistic regression with adjustment for the degree of disc degeneration to evaluate the associations between specific imaging findings and low back symptom severity.ResultsThe prevalence of herniations was 20%, Schmorl's nodes 17%, radial tears 9.9%, high-intensity zone lesions 3.2%, spondylolytic defects 5.8%, and Modic changes 0.7%. Latent class analysis produced 5 clusters: "Always Painful" (n = 65) meant painful at all time points and "Recent Onset Pain" (n = 56) meant increasing symptom severity, whereas subjects in the "Moderately Painful" (n = 73), "Minor Pain" (n = 193), and "No Pain" (n = 167) clusters had fewer symptoms. Compared with the "No Pain" cluster, Schmorl's nodes were more likely to occur in the "Always Painful" cluster (P = 0.017) and herniations in the 3 most painful clusters (P < 0.001). Herniations were associated with low back symptom severity (odds ratio, 2.5; 95% confidence interval, 1.4-4.4). Schmorl's nodes and radial tears were associated with symptoms in crude analyses only, whereas high-intensity zone lesions and spondylolytic defects occurred in similar frequencies in all clusters.ConclusionHerniations were most likely in the subjects with recent onset or persistent (3-yr period) low back symptoms, although they were also detected in subjects with no symptoms. The clinical relevance of herniations on MRI remains to be evaluated in the context of symptoms.

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