A Retrospective Analysis Of Magnetic Resonance Imaging Findings In 20 -40 Year Old Patients With Low Back Pain. Experience At A Semi Urban Tertiary Healthcare Centre In Northern India.

Abstract

Objective– This study was done to assess the spectrum of pathology of lumbar degenerative disc disease via MRI, to correlate MRI findings with the symptomatology and assessment of relevance of MRI findings in young adult patients with low back pain.Methods: A retrospective hospital based study was done of 232 patients who underwent lumbar spine MRI for low back pain symptom complex with exclusion of acute spinal infection, recent trauma, tumors, spinal dysraphism and metabolic conditions from the study. The MRI findings were interpreted independently and subsequently correlated with clinical history and examination findings from patients’ records.Results26 (11.2%) of the 232 patients in the study group had completely normal MRI findings. 2 patients had zygapophyseal joint arthropathy only with no evident diskal abnormality on MRI. Multiple contiguous level disc disease was noted in 138 (59.5%) patients, multiple level disc disease with skipped segments was noted in 14(6%) patients, and 52 (22.4%) patients had single level disc involvement. Disc degeneration on MRI was most frequent at L4-L5 level (79.3% ) followed by L5-S1 level (68.9%), L3-L4 level (32.8%), L2-L3 level (16.3%) and L1-L2 level (9.5%). Disc herniations were most frequent at L4-L5, L5-S1 and L3-L4 levels in decreasing order of frequency. Nerve root compromise was noted most frequently at L4-L5 level (56.9%), followed by L5-S1(41.4%) and L3-L4 (19%) levels. Annular tear was most frequent in L4-L5 intervertebral disc (36.2 % cases), followed by L5-S1 ( 32.8%) , L3-L4 (8.6%) and L2-L3 (3.4%) respectively. Vertebral end plate changes were most common at L5-S1 and L4-L5 vertebral levels with Modic Type II changes (12.5% ) and Type I changes (3.45%). Significant associated findings i.e. transitional vertebra, spondylolysis with anterolistheis of L5 vertebra, Scheuermann disease, Chiari 1 type malformation, thoracic cord syrinx, block L4-L5 vertebra and old healed vertebral pathology not involving lumbar spine were noted in 59 (25.4%) patients.ConclusionThis study shows utility of MRI in depicting objective evidence of lumbar degenerative disc disease in symptomatic young adult patients with clinical suspicion of disease. Foraminal/subarticular disc protrusions/extrusions and significant nerve root compromise on MRI are more likely in clinical setting of radicular pain. Presence of transitional vertebra/ Scheuermann disease, lumbar vertebral neural arch defects, old infective/traumatic pathology in other segments of spine should be investigated in presence of young lumbar degenerative disc disease.