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

Abstract

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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“…Selvaraj R. et al, 35 found that the SLRT was positive in (93.3%) in patients with disc bulge and (60%) in disc protrusion. On the other hand, Dutta S. et al, 36 confirmed that SLRT was positive in (85%), (43%), and (75%) of patients with par central, central and foraminal disc herniation, respectively.…”

Correlation of clinical manifestation of lumbar disc prolapse with magnetic resonance imaging findings among adult patients

“…MRI films and reports of L1/L2, L2/L3, L3/L4, L4/L5 and L5/S1 disc prolapse patients were reviewed. Clinical symptoms, including pain distribution, duration of pain and intensity of pain was assessed using the Numeric Pain Rating Scale, NPRS (0-10) [13] , nerve root compression signs, and neurological signs were assessed at the dermatome level, and the response was recorded in proforma. After clinical assessment, the investigator checked the pinprick sensations using pins, needles or cotton at specific dermatomes (L1, L2, L3, L4, S1).…”

“…1.5 Tesla MRI is most frequently used in most setups, including our study. The 1.5 Tesla MRI scan is used to determine the clinical and intraoperative findings in patients with lumbar disc herniation [13] . Evidence regarding the correlation between MRI findings and clinical symptoms of disc prolapse is not sufficient [14,15] .…”

Pilot study on lumbar canal diameter and walking distance in patients with lumbar spinal stenosis: a multivariate prediction model

“…As medidas do diâmetro do canal medular são melhor mensuradas por ressonância magnética. 3,4 Com o aumento da idade, a prevalência de EEL cresce, sendo prevalente em 9,3% na população geral e chegando a 47% em pessoas com mais de 60 anos. 5 Na faixa etária de 65 anos ou mais, a EEL é a causa mais comum de cirurgias na coluna lombar.…”