SPECTRUM OF MAGNETIC RESONANCE IMAGING FINDINGS IN PATIENTS PRESENTING WITH CHRONIC LOW BACK PAIN: A CROSS-SECTIONAL STUDY FROM A TERTIARY CARE TEACHING HOSPITAL
DOI:
https://doi.org/10.48047/9q2g3c34Keywords:
Chronic low back pain, magnetic resonance imaging, lumbar spine, intervertebral disc degeneration, spinal stenosisAbstract
Background: Chronic low back pain (CLBP) is one of the most frequent reasons for outpatient consultation and imaging referral in India. Magnetic resonance imaging (MRI) is the modality of choice for evaluating the lumbar spine because of its superior soft-tissue contrast and multiplanar capability, yet the spectrum of findings encountered in unselected patients from a South Indian tertiary care setting is incompletely characterised. Objective: To describe the spectrum, distribution and relative frequency of lumbar MRI findings in adults presenting with CLBP and to explore associations of degenerative changes with age, occupation and clinical features. Methods: This hospital-based cross-sectional, descriptive imaging study was conducted in the Department of Radiodiagnosis of a tertiary care teaching hospital in South India over the study period. Consecutive adults with CLBP of more than three months' duration referred for lumbar MRI were included. Imaging was performed on a 1.5 T (or [field strength]) scanner using a standard lumbar protocol, and findings were recorded per intervertebral level. Data were analysed descriptively; chi-square and t-tests were used for associations, with p<0.05 considered significant. Results: Among 300 patients (mean age 51.7 +/- 19.6 years; 173 women, 57.7%), degenerative changes dominated. Disc degeneration prevalence increased caudally, being maximal at L4-L5 (63.7%) and L5-S1 (59.0%). Disc bulge was the commonest morphology (55.0%), followed by protrusion (24.7%). Neural foraminal narrowing (37.0%), facet arthropathy (34.3%) and canal stenosis (22.3%) were frequent. Lumbar spondylosis/degenerative disc disease was the leading impression (75.3%). A small but important minority showed red-flag findings: vertebral compression fracture (2.7%), severe canal stenosis (2.7%) and suspected spondylodiscitis (0.7%). Multilevel degeneration and canal stenosis rose significantly with age (p<0.001). Conclusion: Degenerative disease, maximal at the lower lumbar levels, accounts for the overwhelming majority of MRI findings in South Indian patients with CLBP, while a clinically relevant minority harbour serious pathology. Given the well-recognised imperfect correlation between imaging and symptoms, MRI should be requested judiciously and interpreted alongside clinical findings
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