Dr. Sahil Gupta, Department of Orthopaedics, SGRD University of Health Sciences, Amritsar, Punjab, India E-mail: dr_sahilgupta@yahoo.com
Abstract
Background: Lumbar disc prolapse (LDP) is a leading cause of low back pain and disability worldwide. Magnetic Resonance Imaging (MRI) is considered the gold standard for evaluating disc pathology; however, the correlation between MRI findings and clinical presentation remains inconsistent. This study aimed to evaluate the association between clinical features and MRI findings in patients with lumbar disc prolapse.
Methods: A prospective cross-sectional study was conducted on 60 patients presenting with clinical features suggestive of lumbar disc prolapse at a tertiary care center. Clinical evaluation included assessment of pain severity using the Visual Analogue Scale (VAS), presence of radiculopathy, neurological deficits, and Straight Leg Raising (SLR) test. MRI findings were analyzed for type and level of disc herniation, neural canal compromise, and disc degeneration graded according to the Pfirrmann classification. Statistical analysis was performed using the Chi-square test.
Results: The majority of patients were aged 51–60 years, with a slight male predominance (55%). Disc bulge was the most common type of herniation (56.67%), followed by protrusion (33.33%) and extrusion (10%). The most frequently affected levels were L5–S1 (80%) and L4–L5 (70%). Radiculopathy was present in 90% of patients, and SLR test was positive in 80%. A significant association was found between disc degeneration and sensory (p = 0.001) and motor deficits (p = 0.013), while no association was observed with pain severity.
Conclusion: MRI findings correlate better with neurological deficits than with pain severity; hence, clinical evaluation remains essential for accurate diagnosis and management of lumbar disc prolapse.
Keywords: lumbar disc prolapse, clinical features, MRI findings, low back pain, radiculopathy
References
- 1. Deyo RA, Mirza SK. Herniated lumbar intervertebral disk. N Engl J Med. 2016;374(18):1763–1772. [Google Scholar]
- 2. Stafford MA, Peng P, Hill DA. Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection. Br J Anaesth. 2007;99(4):461–473. [Google Scholar]
- 3. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811–816. [Google Scholar]
- 4. Masui T, Yukawa Y, Nakamura S, Kajino G, Matsubara Y, et al. Natural history of patients with lumbar disc herniation observed by MRI. Spine. 2005;30(2):189–194. [Google Scholar]
- 5. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal MRI scans of the lumbar spine in asymptomatic subjects. J Bone Joint Surg Am. 1990;72(3):403–408. [Google Scholar]
- 6. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, et al. MRI of lumbar spine in people without back pain. N Engl J Med. 1994;331(2):69–73. [Google Scholar]
- 7. Takatalo J, Karppinen J, Niinimäki J, Taimela S, Näyhä S, et al. Does lumbar disc degeneration on MRI associate with low back pain? Spine. 2009;34(23):2478–2483. [Google Scholar]
- 8. Hincapié CA, Cassidy JD, Côté P, Carroll LJ, Guzman J. Whiplash injury and lumbar spine disorders: epidemiology and risk factors. Spine J. 2025;25(1):45–56. [Google Scholar]
- 9. Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA. Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression. J Neurol Neurosurg Psychiatry. 2002;72(5):630–634. [Google Scholar]
- 10. Genevay S, Atlas SJ. Lumbar spinal stenosis. Best Pract Res Clin Rheumatol. 2010;24(2):253–265. [Google Scholar]
- 11. Devillé WL, van der Windt DA, Dzaferagić A, Bezemer PD, Bouter LM. The test of Lasègue: systematic review of diagnostic accuracy. Spine. 2000;25(9):1140–1147. [Google Scholar]
- 12. Modic MT, Masaryk TJ, Ross JS, Carter JR. Imaging of degenerative disk disease. Radiology. 1988;168(1):177–186. [Google Scholar]
- 13. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine. 2001;26(17):1873–1878. [Google Scholar]
- 14. Fardon DF, Milette PC. Nomenclature and classification of lumbar disc pathology. Spine. 2001;26(5):E93–E113. [Google Scholar]
- 15. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood EA, et al. Surgical vs nonoperative treatment for lumbar disc herniation (SPORT trial). JAMA. 2006;296(20):2441–2450. [Google Scholar]
- 16. Lurie JD, Tosteson TD, Tosteson AN, Abdu WA, Zhao W, et al. Long-term outcomes of lumbar disc herniation. Spine. 2014;39(1):3–16. [Google Scholar]
- 17. Samuelly-Leichtag G, Leitner Y, Barak Y, et al. Inflammatory mechanisms in lumbar disc herniation. Pain Res Manag. 2022;2022:1–8. [Google Scholar]
- 18. González-Johnson M, et al. Pain perception and gender differences in musculoskeletal disorders. Pain Med. 2026;27(2):145–152. [Google Scholar]
- 19. Chou R, Qaseem A, Snow V, Casey D, Cross JT, et al. Diagnosis and treatment of low back pain: clinical practice guidelines. Ann Intern Med. 2007;147(7):478–491. [Google Scholar]