Vol 35 | Issue 3 | September-December 2020 | page: 10-14 | Manoj Soni, Muzammil Pheroz, Saumya Agarwal, Arvind Kumar, Shivank Prakash
Authors: Manoj Soni , Muzammil Pheroz , Saumya Agarwal , Arvind Kumar , Shivank Prakash 
 Department of Orthopaedics, Velmed Hospitals, Dehradun, Uttarakhand, India.
 Department of Orthopaedics, Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, India.
 Department of Orthopaedics, Sports Injury Centre, VMMC and Safdarjung Hospital, New Delhi, India.
Address of Correspondence
Dr. Saumya Agarwal,
Senior Resident, Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, India.
Background: Magnetic Resonance Imaging (MRI) is a noninvasive technique that can effectively demonstrate disc degeneration and prolapse which is a major problem in the working individuals. Patients with suspected intervertebral disc prolapse routinely undergo MRI but relevance of associated clinical findings is not an assurity.
Methods: MRI findings and the clinical status of the patients suffering with low backache were assessed with reference to sensitivity, Positive Predictive Value(PPV), Negative Predictive Value (NPV), Odd’s ratio, p-value and a correlation was made in which presence of centro-lateral disc protrusiona and extrusions with gross neural foramen compromise is invariably associated with clinical features. Central disc bulges with thecal sac compromise and without significant neural foramen compromise are clinically not of much significance. The presence of neural foramen compromise is more important in determining the clinical signs and symptoms while the type of disc herniation (disc bulge, disc protrusions) do not correlate well with clinical features. Whenever there are multiple level disc lesions with neural foramen compromise, patients are likely to have objective neurological deficit.
Conclusion: Therefore, before asking for MRI, the patients should be thoroughly evaluated and we must have a clinical diagnosis and a specific question in hand. This will greatly help in correlating the MRI and clinical findings and also in further planning and surgical management of the patients.
Keywords: Low backache, MRI, Lumbar disc prolapse, Disc herniation, Clinical finding.
1. E.P. Szyprit, P. Twining et al. A comparison between magnetic resonance imaging and radiculography. JBJS (Br) 1988; 70 B:717-22.
2. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. JBJS (Am) 1990; 72:403-8.
3. Rankine JJ, Fortune DG, Hutchinson CE, Hughes DG, Main CJ. Pain drawings in the assessment of nerve root compression .a comparative study with lumbar spine magnetic resonance imaging. Spine (phila pa 1976) 1998; 23:1668-76.
4. Buirski G and Silberstien M. The symptomatic lumbar disc in patients with low back pain: Magnetic resonance imaging appearances in both asymptomatic and control population. Spine 1993; 18:1808-1811.
5. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. MRI classification of lumbar intervertebral disc degeneration; Spine(phila pa 1976) 2001; 26:1873-8.
6. Milette PC, Fontaine S, Lepanto L, Cardinal E, Breton G. Differentiating Lowback pain, disc bulges, discs with normal contours but abnormal signal intensity; MRI with disco graphic correlation. Spine (phila pa1976) 1999; 24:44-53.
7. Beattie, Mpyers SP, Stratford P, Millard RW Hollenberg GM. Association between patient report of symptoms and anatomic impairment visible on lumbar MRI. Spine (phila pa 1976) 2000; 25:819- 28.
8. Ito, Manabu Incorvaia KM, Yu SF, Fredrickson BE, Yuan HA, Rosenbaum AE. Predictive signs of discogenic lumbar pain on MRI with discographic correlation. Spine (phila pa 1976)1998; 23:1252-8: Discussion 1259-60.
9. M.C. Powel, M.Wilson, P.Szypryt, E.M. Symonds. Prevalence of lumbar disc degeneration observed by Magnetic Resonance in symptomless women. Lancet.1986;2: 1366-7.
10. Borenstein DG, O’Mara JW Jr, Boden SD, Lauerman WC, Jacobson A, Platenberg C et al. The value of MRI of the lumbar spine to predict low back pain in asymptomatic subjects. JBJS(Am). 2001;83(9):1306-11.
|How to Cite this Article: Soni M, Pheroz M, Agarwal S, Kumar A, Prakash S | Comparative Study Between Clinical And MRI Findings In Lumbar Disc Prolapse | Journal of Bone and Joint Diseases | September-December 2020; 35(3): 10-14.