Correlation between clinical features and magnetic resonance imaging findings in lumbar disc prolapse

P, Janardhana Aithala; Rajagopal, Rajagopal; Rao, Sharath K.; Kamath, Asha

doi:10.4103/0019-5413.65148

Cited by 33 publications

(39 citation statements)

References 13 publications

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“…This clearly shows that MRI evidence of nerve root compression is more likely to produce symptoms. 1 In our study, MRIvisible nerve root contact/compression produce symptomatic levels in 86.4% (51 out of 59 levels), with foramen/lateral recess compromise produce symptomatic levels in 44.4% and those without neural foramen compromise (TSC) produce sympto -matic levels in 7.4% cases, which is almost similar to above study finding.…”

Section: Discussionsupporting

confidence: 89%

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Association between clinically diagnosed lumbar intervertebral disc prolapse and magnetic resonance image findings

Rahman

Islam

et al. 2016

Bangabandhu Sheikh Mujib Medical University Journal

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<p>There are contradictory reports on the findings of magnetic resonance image (MRI) in lumbar intervertebral disc prolapse. A study was conducted on 54 patients using 3 of 4 clinical criteria (low back pain with radiation down to the lower limbs, radicular pain along specific dermatomes, positive straight leg raising test, presence of neurological symptoms and signs e.g. motor or sensory deficit and MRI of lumbosacral spine of the respondent). Evaluation of MRI of lumbosacral spine was done based on extent of disc prolapse, disc degeneration, nerve root compression neural foramen compromise. The logistic regression analysis between the findings of MRI and the clinical features show that there was a significant association in the neural foramen or lateral recess (Odd's ratio 7.106, p<0.05), the root compression (p<0.01) as well as the disc extrusion (p<0.05). There was no statistical association between clinical levels and other MRI findings like disc protrusion and disc bulge (p value 0.21 and 0.14, respectively). The strength of agreement between clinical and MRI diagnosis level of disc prolapse was calculated using kappa statistics (k-value). The test revealed a very good agreement for L3/4 (k-value = 0.812) and good agreement for L4/5 and L5/SI level (k-value 0.75 and 0.75 respectively) between these two procedures, suggesting that level of disc prolapse could be correctly diagnosed without MRI findings. In conclusion, clinically diagnosed levels associate well with MRI levels, but all MRI abnormalities do not have any clinical significance.</p><p> </p>

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Section: Discussionsupporting

confidence: 89%

“…1 The clinically significant sciatica due to disc prolapse is 4-6%. 2 In 85% of cases, no specific diagnosis can be made.…”

Section: Introductionmentioning

confidence: 99%

Association between clinically diagnosed lumbar intervertebral disc prolapse and magnetic resonance image findings

Rahman

Islam

et al. 2016

Bangabandhu Sheikh Mujib Medical University Journal

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“…Few studies have analyzed the correlation between clinical findings and MRI scans for lumbar disc herniation [61112]. To our knowledge, the present study is the first to extend this correlation to intraoperative findings.…”

Section: Discussionmentioning

confidence: 59%

“…MRI scans are available in various magnetic field strengths, with 1.5 Tesla being the most commonly used in India. Several studies have reported on the high sensitivity of this imaging modality [45678]. However, MRI studies in selected volunteers have also shown up to a 36% incidence of disc protrusion and extrusion in patients without symptoms, thus highlighting their low predictive value for the development of back and leg pain [910].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, it is important to define the correlation between MRI findings and clinical features, as well as to define their degree of correlation with intraoperative findings. Although some studies have correlated MRI scans with clinical findings [61112], to our knowledge there are none that have also included intraoperative findings. The aim of the present study was to determine the correlation of a 1.5 Tesla MRI scan with clinical and intraoperative findings in patients with lumbar disc herniation.…”

Section: Introductionmentioning

confidence: 99%

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Correlation of 1.5 Tesla Magnetic Resonance Imaging with Clinical and Intraoperative Findings for Lumbar Disc Herniation

2016

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Study DesignA single-center prospective study.PurposeA magnetic resonance imaging (MRI) scan is undeniably the gold standard for the diagnosis of a lumbar disc prolapse. Unfortunately it shares a strong association with incidental findings. In this study, we aimed to determine the extent to which a 1.5 Tesla MRI correlates with the clinical features and intraoperative findings in cases of lumbar disc prolapse.Overview of LiteratureFew studies have correlated MRI with clinical findings, and none have extended this correlation to intraoperative findings.MethodsOver a 2-year period, 50 consecutive patients with lumbar disc herniation requiring discectomy were studied. The MRI findings we observed consisted of the prolapse level, type, position, migration, high-intensity zones (HIZ), lateral recess, and foraminal stenosis. A logistic regression analysis was performed to determine the significance for the various MRI findings. Finally, the MRI observations were confirmed with intraoperative findings and inferences were drawn.ResultsMRI scan sensitivity and specificity for determining surgically significant levels was 100% and 94.94%, respectively. Straight leg raising test was positive in 74% of patients, with 85%, 43%, and 75% for paracentral, central, and foraminal levels, respectively. A foraminal compromise was the only MRI parameter to share a significant association with neurological deficits. Patients with a HIZ on the MRI had a significant increase in back pain and 63% exhibited identifiable annular tears intraoperatively. The intraoperative anatomical findings correlated extensively with the MRI findings.ConclusionsMRI findings strongly correlate with intraoperative features and can serve as a useful tool when planning surgery due to the accurate depiction of the morphometric features. However, the decision for surgery should be made only when detailed clinical findings in conjunction with MRI findings allow for an accurate identification of the culprit fragment and pain generators.

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Lumbosacral Radicular Pain

Boxem¹,

Cheng

Patijn

et al. 2011

Evidence‐Based Interventional Pain Medicine

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Introduction: Patients suffering lumbosacral radicular pain report radiating pain in one or more lumbar or sacral dermatomes. In the general population, low back pain with leg pain extending below the knee has an annual prevalence that varies from 9.9% to 25%. Methods: The literature on the diagnosis and treatment of lumbosacral radicular pain was reviewed and summarized. Results: Although a patient's history, the pain distribution pattern, and clinical examination may yield a presumptive diagnosis of lumbosacral radicular pain, additional clinical tests may be required. Medical imaging studies can demonstrate or exclude specific underlying pathologies and identify nerve root irritation, while selective diagnostic nerve root blocks can be used to confirm the affected level(s). In subacute lumbosacral radicular pain, transforaminal corticosteroid administration provides short-term pain relief and improves mobility. In chronic lumbosacral radicular pain, pulsed radiofrequency (PRF) treatment adjacent to the spinal ganglion (DRG) can provide pain relief for a longer period in wellselected patients. In cases of refractory pain, epidural adhesiolysis and spinal cord stimulation can be considered in experienced centers. Conclusions: The diagnosis of lumbosacral radicular pain is based on a combination of history, clinical examination, and additional investigations. Epidural steroids can be considered for subacute lumbosacral radicular pain. In chronic lumbosacral radicular pain, PRF adjacent to the DRG is recommended. SCS and epidural adhesiolysis can be considered for cases of refractory pain in specialized centers.

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Correlation between clinical features and magnetic resonance imaging findings in lumbar disc prolapse

Cited by 33 publications

References 13 publications

Association between clinically diagnosed lumbar intervertebral disc prolapse and magnetic resonance image findings

Association between clinically diagnosed lumbar intervertebral disc prolapse and magnetic resonance image findings

Correlation of 1.5 Tesla Magnetic Resonance Imaging with Clinical and Intraoperative Findings for Lumbar Disc Herniation

Lumbosacral Radicular Pain

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