Correlation of Magnetic Resonance Imaging findings with Clinical Grading in Lumbar Disc Degeneration: A Cross-sectional Study

Abstract

Introduction: Low Back Pain (LBP) is the most common musculoskeletal symptom encountered on a daily basis in clinical practice and has a significant impact on healthcare resources. Magnetic Resonance Imaging (MRI) is the most sensitive tool for diagnosing spinal degenerative disease and has proven to be a standard imaging modality for its evaluation. Assessment of the correlation between clinical and radiological severity of lumbar disc degeneration will help in better management of the LBP patients. Aim: To determine the correlation between the clinical and radiological severity of lumbar disc degeneration in non surgical LBP patients. Materials and Methods: This observational, cross-sectional study was conducted at the Department of Radiology and Imaging, Sagar Hospitals, Bengaluru, Karnataka, India, from December 2019 to June 2021. A total of 90 patients with LBP who were referred for MRI evaluation were included. Modified Oswestry questionnaire was given to the patients and the clinical severity of the LBP was quantified. Patients with disc degeneration were evaluated on MRI based on six parameters viz., T2-signal intensity, Disc Extension Beyond Interface (DEBIT), annular fissure, modic changes, endplate integrity and osteophytes. Fisher's exact test was used for qualitative data to look into the association between clinical and MRI grades of severity. Correlation was assessed for continuous variables using Pearson correlation analysis. Results: The study included a total of 90 patients with LBP, with a mean age of 57±13.75 years with equal sex preponderance (45 (50%) male and 45 (50%) female). Clinically, 51 (56.7%) of the study population revealed moderate disability. On quantifying the MRI total score of disc degeneration, 65 (72.3%) of the patients were found to show mild degeneration. In terms of involvement of all the evaluated six MRI parameters, the L4-L5 disc was most commonly affected, followed by the L5-S1 disc. Disc desiccation 353 (78.45%) and osteophytes 336 (74.67%) were the most consistently observed variations. Disc bulges 251 (55.78%) were the next most frequently observed parameter in disc degeneration. Conclusion: The correlation between the clinical and radiological severity of disc degenerative disease was found to be weakly positive and statistically insignificant. Disc desiccation, osteophytes and disc bulges were the most commonly observed parameters that contributed to lumbar degenerative disease.