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Diagnostic accuracy of MRI for identifying posterior element bone stress injury in athletes with low back pain: a systematic review and narrative synthesis
  1. Roy Esh1,
  2. Linn Helen J Grødahl2,
  3. Robert Kerslake3,
  4. Kate Strachan4,
  5. Simon Spencer5,
  6. Louise Fawcett6,
  7. Alison Rushton7,
  8. Nicola R Heneghan7
  1. 1 School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  2. 2 The Norwegian Sport Medicine Clinic, Oslo, Norway
  3. 3 Radiology, Queen’s Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
  4. 4 Loughborough Performance Centre, English Institute of Sport, Loughborough University, Loughborough, UK
  5. 5 Physiotherapy, English Institute of Sport, Manchester, UK
  6. 6 British Gymnastics, English Institute of Sport, Newport, UK
  7. 7 Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  1. Correspondence to Nicola R Heneghan; n.heneghan{at}bham.ac.uk

Abstract

Objective To investigate the diagnostic accuracy of MRI for identifying posterior element bone stress injury (PEBSI) in the athletic population with low back pain (LBP).

Study Design A systematic review searched for published sources up until July 2020. Eligibility criteria: prospective cohort design, MRI diagnosis, adolescents/young adults, chief symptoms of LBP, PEBSI as the clinical diagnosis and SPECT-CT as reference standard. Risk of bias and overall quality were assessed using QUADAS-2 and GRADE, respectively. A narrative synthesis was conducted.

Results Four studies were included, with three included in the quantitative synthesis. Compared with SPECT-CT, two studies involving MRI demonstrated sensitivity and specificity of 80% and 100%, and 88% and 97%, respectively. Compared with CT, one study involving MRI demonstrated sensitivity and specificity of 97% and 91%, respectively. Risk of bias was moderate to high although consistency across studies was noted.

Conclusion Findings support further research to consider MRI as the modality of choice for diagnosing PEBSI. MRI was consistent with SPECT-CT for ruling-in PEBSI, but the clinical value of cases where MRI had false negatives remains uncertain due to possible over-sensitivity by SPECT-CT.

PROSPERO registration number CRD42015023979.

  • Diagnosis
  • Back injuries
  • Evidence based review
  • Athlete
  • MRI
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjsem-2020-000764

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    Footnotes

    • Twitter Nicola Heneghan @Nicola_Heneghan.

    • Contributors The initial protocol and design were developed by RE, RK, KS, SS, LF, AR and NRH; RE, LHJG, RK, KS and NRH were involved in the completion of searches, data extraction, quality assessment and analysis; all authors contributed to the interpretation and write-up of the study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.