Main text: We aim to summarize the available evidence on the diagnostic accuracy of imaging (index test) compared to surgery (reference test) for identifying lumbar disc herniation (LDH) in adult patients.
For this systematic review we searched MEDLINE, EMBASE and CINAHL (June 2017) for studies that assessed the diagnostic accuracy of imaging for LDH in adult patients with low back pain and surgery as the reference standard. Two review authors independently selected studies, extracted data and assessed risk of bias. We calculated summary estimates of sensitivity and specificity using bivariate analysis, generated linked ROC plots in case of direct comparison of diagnostic imaging tests and assessed the quality of evidence using the GRADE-approach.
We found 14 studies, all but one done before 1995, including 940 patients. Nine studies investigated Computed Tomography (CT), eight myelography and six Magnetic Resonance Imaging (MRI). The prior probability of LDH varied from 48.6 to 98.7%. The summary estimates for MRI and myelography were comparable with CT (sensitivity: 81.3% (95%CI 72.3–87.7%) and specificity: 77.1% (95%CI 61.9–87.5%)). The quality of evidence was moderate to very low.
Conclusions: The diagnostic accuracy of CT, myelography and MRI of today is unknown, as we found no studies evaluating today’s more advanced imaging techniques. Concerning the older techniques we found moderate diagnostic accuracy for all CT, myelography and MRI, indicating a large proportion of false positives and negatives.
Author keywords: Diagnostic accuracy — Systematic review — Lumbar disc herniation —-Diagnostic imaging — Low back pain
Author affiliations: JHK, RMvR, BWK: Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands; JHK: Department of Family Medicine, Chung-ang University Medical Center, Seoul, South Korea; RMvR, APV: Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands; MWvT, MRdB, RWGJO: Department of Health Sciences and EMGO-Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Medical Centre, Amsterdam, The Netherlands; MWvT, RWGJO: Department of Epidemiology and Biostatistics and EMGO-Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; AXG: Department of Radiology, Erasmus University Medical Centre, Rotterdam, Netherlands; DAMWvdW: Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK; APV: School of Physiotherapy, Graduate school of Health, University Technology Sydney, Sydney, Australia
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