CORRELATION BETWEEN CLINICAL AND MRI FINDINGS WITH INTRAOPERATIVE FINDINGS IN LUMBAR INTERVERTEBRAL DISC PROLAPSE

Abstract

Background Low Back Pain is a musculoskeletal condition that arises in the lumbar area as a result of significant stress. Disc herniation is a complex diagnosis since it involves not only finding the specific structural abnormality causing the patient's pain, but also comparing the individual's complaints and signs with MRI findings. Since MRI tests have surpassed older investigative procedures, they have become the gold standard for diagnosing herniated discs. It is now considered to be the benchmark in herniated disc diagnosis. Aim and Objective To describe the clinical, MRI and Intra operative findings in Lumbar Intervertebral disc prolapse among the study patients and to find out the correlation between those findings. Methodology This prospective observational study included 47 patients hospitalized to RL Jalappa hospital from September 2022 to December 2023, diagnosed with Lumbar Intervertebral disc prolapse, and having had unsuccessful conservative therapy for a minimum of eight weeks in the Orthopaedics department. The clinical criteria that were used included LBP radiating to lower limb and presence of neurological deficit. The MRI findings that were recorded included xvii location, type, migration, level of prolapse, high intensity zone along with presence of lateral recess and foraminal stenosis. Patients who met both the clinical and MRI criteria were selected for surgical treatment. Then intraoperative findings were correlated with Clinical and MRI findings among patients. Results The average age of patients diagnosed as LIDP was 43.66 ± 9.38 yrs. The study found that 78.7% of the subjects were male, while the remaining 21.3% were female. Among the study participants with LIDP, bilateral radiculopathy was found in 14.9% of them. Left radiculopathy was seen in 53.2% of the samples, while right radiculopathy was observed in 31.9% of the patients. The MRI results indicate that 59.6% of the subjects exhibited intervertebral disc prolapse at the L4-L5 region. About 38.3% of the research participants had lumbar disc herniation in the central position, the central and left paracentral location were the second most frequently seen (21.3%), followed by the right paracentral location (12.8%). A annular tear was seen in the MRI results of 59.6% of the individuals included in the research. The MRI results indicate that among the study samples, 36.2% exhibited LRFS on the left side, whereas 21.3% showed these conditions on the right side. Among the study's samples, the most prevalent kind of lumbar disc herniation observed after surgery was extrusion, accounting for 57.4% of cases. The operative findings revealed that 34% of the xviii research samples had a lateral recess on the left side, whereas 21.3% of the study participants had it documented on the right side. The research samples exhibited bilateral presence in approximately 31.9% of cases. Operative findings revealed that 25.5% of the research samples had foraminal stenosis on the left side, whereas 48.9% of the studied samples exhibited bilateral presence. An 87.2% correlation was reported between the clinical, MRI, and surgical data among the research participants in this investigation. The study found that the most frequent occurrence of nerve root compression among the patients was identified at the left Traversing L5 level. Conclusion The accurate representation of morphometric features in MRI scans makes them a useful tool for preparing for surgery, and there is a robust positive correlation between IOF and MRI results. Nevertheless, the choice to have surgery should only be taken when a thorough examination of clinical evidence, together with MRI results, enables a precise identification of the specific fragment causing the problem and the sources of discomfort.