Correlation between Clinical Features and Magnetic Resonance Imaging Findings in Lumbar Disc Prolapse

Abstract

Introduction: Lumbar disc prolapse is one of the most commonly diagnosed abnormalities associated with low back pain. It can be asymptomatic in some but can be symptomatic in others. This study was conducted to correlate the clinical findings and magnetic resonance imaging (MRI) in symptomatic patients with lumbar disc prolapse.

Method: Forty one symptomatic patients with lumbar disc prolapse over a period of one year (July 2017-June 2018) were studied regarding demographic details, dermatome, motor straight leg raising test (SLRT). MRI of those symptomatic patients were done to evaluate the level of disc prolapse, type of herniations, neural foramen compromise and nerve root compression. These MRI findings were then correlated with clinical signs and symptoms.

Result: Out of 41 patients, 60.95% were male. Mean age of the patients was (36.14 ± 7.70 ) years with ranges from 21 to 50 years. Among them, 63.41% patients presented with low back pain. Radiculopathy was present in 95.12%. L5 nerve root involvement was most common neurological finding (56.10 %). SLRT was positive in 68.30%. In MRI, there were 78 disc herniations with 58.53% position paracentral and 55.14% disc bulge. Mostly (87.80%) were at the level of L4-L5 and L5-S1 (87.80%). There were statistically significant correlation between MRI findings of disc bulge and neurological signs (p=0.02), neural foramen compromise and neurological deficit (p=0.051), nerve root compression and neurological deficit (p=0.02) and absent ankle jerk (p=0.03). The clinical level atL5-S1 (p=0.003) and MRI level L5-S1 (0.04) had statistically significant correlations.

Conclusion: Neurological deficits correlated significantly with MRI findings of neural foraminal compromise, nerve root compression and L5-S1 level lesion. However, bulge, protrusion, extrusion, SLRT and radicular pain did not correlate with neurological deficits.