CORRELATION BETWEEN MRI FINDINGS AND CLINICAL SEVERITY IN LUMBAR DISC HERNIATION PATIENTS IN A TEACHING HOSPITAL SETTING
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Keywords
Lumbar disc herniation, MRI findings, clinical severity, Oswestry Disability Index, correlation study
Abstract
Lumbar disc herniation represents a significant cause of lower back pain and disability in the adult population. While magnetic resonance imaging (MRI) is the gold standard for diagnosing disc herniation, the correlation between radiological findings and clinical severity remains inconsistent in clinical practice.
Objectives: To evaluate the correlation between MRI findings and clinical severity in patients with lumbar disc herniation presenting at M M Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, and to determine whether radiological severity predicts functional disability.
Methodology: A cross-sectional observational study was conducted from July 2024 to December 2024 at the Department of Radiodiagnosis and Orthopedics. A total of 120 patients with lumbar disc herniation confirmed on MRI were enrolled using consecutive sampling. Clinical severity was assessed using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS), while MRI findings were graded according to disc herniation type, nerve root compression, and spinal canal stenosis. Statistical analysis was performed using SPSS version 26.0, employing Spearman's correlation coefficient and chi-square tests.
Results: The mean age of participants was 42.8±11.2 years, with male predominance (58.3%). L4-L5 and L5-S1 were the most commonly affected levels (67.5%). Moderate positive correlation was found between disc herniation grade and ODI scores (r=0.542, p<0.001). Severe nerve root compression showed significant association with higher VAS scores (p<0.001). However, 23.3% of patients with severe MRI findings reported mild symptoms, indicating discordance between imaging and clinical presentation.
Conclusion: While significant correlation exists between MRI findings and clinical severity in lumbar disc herniation, imaging alone cannot predict functional disability. Clinical assessment remains paramount in patient management, and treatment decisions should not be based solely on radiological findings.
References
2. Amin RM, Andrade NS, Neuman BJ. Lumbar disc herniation. Curr Rev Musculoskelet Med. 2017;10(4):507-16.
3. Sharan D, Rajkumar JS, Mohandoss M, Ranganathan R. Myofascial low back pain treatment. Curr Pain Headache Rep. 2014;18(9):449-56.
4. Modic MT, Ross JS. Lumbar degenerative disk disease. Radiology. 2007;245(1):43-61.
5. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-6.
6. Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine (Phila Pa 1976). 2015;40(6):392-8.
7. el Barzouhi A, Vleggeert-Lankamp CL, Lycklama à Nijeholt GJ, Van der Kallen BF, van den Hout WB, Jacobs WC, et al. Magnetic resonance imaging in follow-up assessment of sciatica. N Engl J Med. 2013;368(11):999-1007.
8. Steffens D, Hancock MJ, Maher CG, Williams C, Jensen TS, Latimer J. Does magnetic resonance imaging predict future low back pain? A systematic review. Eur J Pain. 2014;18(6):755-65.
9. Abdollah V, Parent EC, Wachowicz K, Battié MC. Multifidus muscle morphology in lumbar spine MRI: A comparison between pain developers and matched controls in a longitudinal study. Spine J. 2022;22(8):1313-22.
10. Kim HS, Wu PH, Jang IT. Lumbar disc herniation: a review of the current surgical management options. Neurospine. 2020;17(1):S11-21.
11. Zhang Z, Song L, Meng Q, Li Z, Luo Y, Zhan S, et al. Lumbar nerve root compression evaluated by magnetic resonance neurography: a preliminary study. BMC Musculoskelet Disord. 2021;22(1):826.
12. Sharma S, Pathak A, Jensen MP, Sharma S, Poole C, Gosai F, et al. State of clinical pain research in India: Where do we stand and where do we go from here? J Pain Res. 2017;10:2543-52.
13. Patel DR, Kinsella E. Evaluation and management of lower back pain in young athletes. Transl Pediatr. 2017;6(3):225-35.
14. Desai MJ, Nava A, Rigoard P, Shah B, Taylor RS. Optimal medical, rehabilitation and behavioral health management of complex regional pain syndrome: a review of clinical evidence. J Pain Res. 2021;14:675-89.
15. Liu J, Peng P, Liang M, Wei X, Xie W, Zhang T, et al. Psychosocial factors and their association with pain, physical function and quality of life in chronic low back pain. J Pain Res. 2022;15:3815-23.
16. Nakamura SI, Takahashi K, Takahashi Y, Morinaga T, Shimada Y, Moriya H. Origin of nerves supplying the posterior portion of lumbar intervertebral discs in rats. Spine (Phila Pa 1976). 1996;21(8):917-24.
17. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25(22):2940-52.
18. Chen Y, Campbell P, Strauss VY, Foster NE, Jordan KP, Dunn KM. Trajectories and predictors of the long-term course of low back pain: cohort study with 5-year follow-up. Pain. 2018;159(2):252-60.
19. Jensen RK, Leboeuf-Yde C, Wedderkopp N, Sorensen JS, Jensen TS, Manniche C. Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI. Eur Spine J. 2012;21(11):2271-9.
20. Chou R, Qaseem A, Owens DK, Shekelle P. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Ann Intern Med. 2011;154(3):181-9.
21. Risbud MV, Shapiro IM. Role of cytokines in intervertebral disc degeneration: pain and disc content. Nat Rev Rheumatol. 2014;10(1):44-56.
22. Komori H, Shinomiya K, Nakai O, Yamaura I, Takeda S, Furuya K. The natural history of herniated nucleus pulposus with radiculopathy. Spine (Phila Pa 1976). 1996;21(2):225-9.
23. Steurer J, Roner S, Gnannt R, Hodler J. Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review. BMC Musculoskelet Disord. 2011;12:175.
24. Peng B, DePalma MJ. Cervical disc degeneration and neck pain. J Pain Res. 2018;11:2853-7.
25. Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545-602.
26. Ramond A, Bouton C, Richard I, Roquelaure Y, Baufreton C, Legrand E, et al. Psychosocial risk factors for chronic low back pain in primary care: a systematic review. Fam Pract. 2011;28(1):12-21.
27. Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth. 2013;111(1):52-8.
28. ACR Appropriateness Criteria: Low back pain. American College of Radiology; 2020. Available from: https://acsearch.acr.org/docs/69483/Narrative/
29. Patel V, Parikh R, Nandraj S, Balasubramaniam P, Narayan K, Paul VK, et al. Assuring health coverage for all in India. Lancet. 2015;386(10011):2422-35.
30. Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373(9662):463-72.
31. Waddell G, Burton AK. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med (Lond). 2001;51(2):124-35.
32. Diatchenko L, Nackley AG, Slade GD, Fillingim RB, Maixner W. Idiopathic pain disorders: pathways of vulnerability. Pain. 2006;123(3):226-30.
33. Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2015;29(2):184-95.
34. National Guideline Centre (UK). Low back pain and sciatica in over 16s: assessment and management. London: National Institute for Health and Care Excellence (UK); 2016.
35. Waddell G. The back pain revolution. 2nd ed. Edinburgh: Churchill Livingstone; 2004.
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Dr. Jaimin Rajendrakumar Modi
Assistant Professor, Department of Radio-Diagnosis, MM Institute of Medical Sciences & Research, Mullana-Ambala, Haryana, India
Dr. Ankur R. Parikh
Assistant Professor, Department of Orthopaedics, MM Institute of Medical Sciences & Research, Mullana-Ambala, Haryana, India
Dr. Rahul Mohan
Assistant Professor, Department of Radio-Diagnosis, RDJMMCH, Turki Muzaffarpur, Bihar, India
