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FRI0232 Importance of the radiological studies in the diagnosis of the chronic low back pain
  1. FP Pérez-Torres,
  2. D Ybañez-García,
  3. P Pérez-Caballero,
  4. M Morales,
  5. A Llópis
  1. Reumathology, Hospital General Requena, Requena, España

Abstract

Objectives Classify the radiological alterations in patients with chronic low back pain (LBP) and to determine their relationship with symptomatology, and value the contribution carried out in the classification by diagnostic groups.

Methods A longitudinal study of patients that required specialised attendance in the period of time January 95–96 by LBP. All patients were carried a standard radiological study out and the found alterations were classified as alterations of the development and the statics, of the articulate space and of the bony density. Classified the patients in a retrospective way it was determined the contribution of the radiology like confirmed case, probable case, possible case and no case. A statistical study was realised determining absolute and relative frequencies, and χ2 test with a level of trust of 95%.

Results Of a total of 472 selected patients, 334 presented alterations of the static (70,8%) and it was a significant relationship between these alterations and all the diagnostic groups for a value of p < 0.0001, except for the groups inflammatory illnesses and alterations for physical agents. Alterations of the articulate space in 362 cases (76,7%), with a significant relationship between these alterations and the spondyloarthropaty (p < 0.001), degenerative modifications and bony illnesses (p < 0.0001). Alterations of the bony density in 361 cases (76,4%), with a significant relationship for all the groups (p < 0.001) except functional dysfunctions and physical agents.

The value of the radiology in the classification of patients was useful (p < 0.0001) in the spondyloarthropaty groups and anomalies of the development, it didn’t have value (p < 0.0001) in functional dysfunctions and physical agents. Orientation value as possible-probable case (p < 0.0001) in the degenerative modifications groups and bony metabolic illnesses.

Conclusion 1. Radiological signs predictor of classification are the sclerosis and the ankylosis of sacroiliac joint for the inflammatory illnesses, spondylolysis/spondylolisthesis for anomalies of the development and increase of the discal space for metabolic bony illnesses. 2. The radiology is useful to classify in the inflammatory illnesses and anomalies of the development, it hasn’t value in the functional dysfunctions groups and alterations for physical agents, it has an orientation value in degenerative modifications groups and bony illnesses. 3. A 15% of the cases have bony alterations that aren’t related with the simptomatology and the diagnosis.

References

  1. Gehweiler JA, Daffner RH. Low back pain: the controversia of radiologic evaluation. AJR 1983;140:109–12

  2. Suarez-Almazor ME, Belseck E, Russell AS, Mackel JV. Use of lumbar radiographs for the early diagnosis of low back pain. J Am Med Assoc. 1997;277:1782–6

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