The Superiority of Plain Radiography to Magnetic Resonance Imaging in Determining Lumbar Lordosis Angles in Patients with Disc Herniation

Abstract

Objective: It is estimated that about 80% of general population experience low back pain lifetime. Decreased lumbar lordosis is one of the important findings of disc disease and degenerative process is the result. In this retrospective study, Magnetic Resonance Imaging (MRI) and direct radiographs were used to measure lordosis in patients with disc herniation and compared to patients with low back pain without disc herniation. Materials and Methods: Patients admitted to outpatient clinics of our institution with low back pain and sciatalgia between 2014 and 2017 were enrolled in the study. In present retrospective study, MRI and plain radiographic images were obtained and evaluated. Patients with disc hernia in L4–5 or L5–S1 level were determined. Control group were consisted of healthy subjects whom low back pain was not caused by disk herniation. Lumbar lordotic angle was measured by an experienced radiologist by Cobb method. Results: The lumbar spinal angles measured by plain radiography were 45.41±11.53 mm in the patient groups with disc hernia, and 54.87±8.80 mm in the control group (Fig. 2). The difference between the study groups was significant (p < 0.001). The lumbar lordosis angles measured by MRI were 41.65±8.50 mm in the patient groups with disc hernia, and 44.85±7.58 mm in control group. The difference between the study groups did not reach a significant level (p = 0 428) (Fig. 3). Conclusion: Lumbar disc herniation decreases lumbar lordosis and we suggest that lumbar lordotic angles should be measured by direct plain radiographies in standing position in these patients. Nevertheless, beside a detailed medical history and physical examination, the diagnosis and treatment should be decided by a combination of MRI and standing plain radiograph in subjects with herniated lumbar discs.