Diagnostic value of musculoskeletal ultrasound in patients with low back pain – a review of the literature

Abstract

Low back pain (LBP) occurs in various groups of the population, affects men and women equally, and is among the major reasons for rheumatological or orthopedic consultations. Its prevalence increases steadily with age and the rate of recurrence within one year could reach 44% [1]. Many imaging modalities are available to clinicians for evaluating LBP. The application of these modalities depends mainly on the working diagnosis, the urgency of the clinical problem, the availability, and the comorbidities of the patient [2]. Conventional radiography (CR) and computerized tomography (CT) are associated with radiation exposure and show primarily the bony elements of the lower back. Their widespread use in the 20th century might be among the reasons why paraspinal soft tissues have somehow been neglected as a cause for LBP [1]. Magnetic resonance imaging (MRI) shows both bony and soft tissue structures in the axial skeleton, but its use is hampered by the duration of the examination, its relatively high costs, its limited availability (mainly in the tertiary centers) and the contraindications for this diagnostic modality [2].Musculoskeletal ultrasound (US) is a safe, fast, inexpensive, and widely available imaging modality that is very well tolerated by patients [3]. It allows multiplanar and dynamic examinations of the musculoskeletal system and can show the soft tissues in great anatomical detail. US is used by a growing number of physicians and the list of its applications in rheumatology and orthopedics is growing [4].Therefore, the question of the possible diagnostic application of US in such a common condition as LBP is very relevant to the clinical practice. On one hand, this could decrease the radiation exposure associated with CR and CT, and reduce the costs paid for MRI. The effect could be even bigger in time, as LBP is frequently a chronic or recurrent disease [1]. On the other hand, by AbstractPatients with low back pain (LBP) frequently undergo various imaging studies in the pursuit of a more precise diagnosis. Ultrasound (US) has the advantage of being a widely available, multiplanar, fast and radiation-free diagnostic tool. Moreover, compared to most of the other imaging modalities, it is particularly efficient in the visualization and assessment of soft tissues. Consequently, the question about the possible diagnostic application of US in such a common pathology as LBP is very relevant to the clinical practice. For this reason, we performed a review of the literature on the diagnostic value of US in different conditions that could cause LBP. We hereby discuss available studies on the diagnostic application of US in spinal canal stenosis and disc herniation (probably of historical significance only), as well as in the pathology of soft tissue structures like the lumbar and pelvic ligaments, muscles and entheses, the thoracolumbar fascia and the sacroiliac joints (maybe of greater importance nowadays). The evidence for the diagnostic value of US is not equivocal, though promising for some of the causati...

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