MAGNETIC RESONANCE IMAGING (MRI) FINDINGS IN LUMBAR DISC DISEASE: CORRELATION WITH ANESTHETIC CHALLENGES AND SURGICAL OUTCOMES"

Abstract

Lumbar disc disease is a common cause of back pain and radiculopathy, often necessitating surgical intervention. Preoperative assessment using magnetic resonance imaging (MRI) is critical for identifying disc herniation, nerve root compression, spinal canal stenosis, and degenerative changes. These findings not only guide surgical planning but also influence anesthetic management, including the choice between general, regional or combined anesthesia, as well as patient positioning and perioperative risk stratification.

Objectives: The study aimed to assess how preoperative MRI findings in lumbar disc disease influence anesthetic management and surgical outcomes, by evaluating the relationship between MRI pathology and anesthetic complexity, and determining the impact of MRI severity on surgical parameters and postoperative recovery. It emphasized integrating radiological, surgical, and anesthetic evaluations for optimized perioperative care.

Methodology: This prospective observational study included 120 adult patients diagnosed with lumbar disc disease on MRI and scheduled for elective lumbar disc surgery. MRI scans were analyzed for disc level involvement, nerve root compression, multilevel disease, and degenerative changes. Preoperative anesthetic assessment recorded ASA status, comorbidities, and anticipated challenges. Intraoperative data included anesthetic technique, positioning difficulties, hemodynamic instability, and regional block success, while surgical outcomes encompassed duration, blood loss, postoperative recovery time, and pain scores.

Results: The study population had a mean age of 44.2 ± 12.8 years, with 54.2% males. MRI revealed single-level disc herniation in 43.3%, multilevel involvement in 31.7%, nerve root compression in 58.3%, spinal canal stenosis in 20.8%, and degenerative changes in 50% of patients. General anesthesia was administered in 48.3%, regional in 35%, and combined anesthesia in 16.7%. Severe MRI findings, including multilevel disease and significant nerve root compression, were associated with increased anesthetic complexity, higher rates of general or combined anesthesia, difficult positioning, and occasional regional block failure. Surgical duration and intraoperative blood loss increased proportionally with MRI severity, while postoperative recovery time and pain scores were also higher in patients with more severe pathology. Conclusion: MRI evaluation in lumbar disc disease provides essential guidance for both surgical and anesthetic planning. Patients with severe or multilevel disc pathology are more likely to present anesthetic challenges and require careful preoperative preparation. Integration of MRI findings into perioperative assessment enhances patient safety, optimizes anesthetic strategies and improves surgical outcomes, emphasizing the importance of multidisciplinary collaboration between radiologists, surgeons and anesthesiologists.