MAGNETIC RESONANCE IMAGING IN LUMBAR DEGENERATIVE DISEASE AND CORRELATION WITH MODIFIED OSWESTRY DISABILITY INDEX

Abstract

INTRODUCTION Lumbar degenerative disease is one of the common causes for low back pain may and may cause debilitation. Many structural components of spine are responsible for low backache of degenerative etiology including the intervertebral disc, vertebral periosteum, facet joints and spinal ligaments. The most frequent and common location of these changes is lumbar spine due to heavy mechanical stress. In MRI of spine the term degeneration referred to any one or more among the following imaging findings including, , diffuse bulging (central, subarticular, foraminal and extraforaminal) or herniation of the disc (protrusion, extrusion, sequestration and migration), annulus fissuring, annulus tears, modic changes(type I, II, III) in end plates, facetal arthropathy, ligamentum flavum hypertrophy, neural foramen stenosis (grade I,II,III) and, spinal canal stenosis (grade I,II,III) osteophytes at the vertebral apophyses. OBJECTIVES 1. To assess MRI findings in individuals experiencing low back pain due to lumbar degenerative disease. 2. To characterize the MRI grading of neural foraminal narrowing and spinal canal stenosis. 3. To correlate the observed MRI findings with severity of self-assessed Modified Oswestry Disability Index in patients. xvii MATERIAL AND METHODS This study is a prospective study carried out in the Department of Radiodiagnosis, department of Radiology at R.L.J Hospital and Research Centre, attached to Sri Devaraj Urs Medical College between June 2022 and September 2024, after obtaining the approval from Institutional Ethics Committee. It included 100 consenting patients of all age groups irrespective of sex, having low back pain who were referred for MRI lumbar spine. Patients not consenting for study, Low back pain due to infective or neoplastic etiology, History of trauma or operative intervention for low back ache, Patient with claustrophobia and uncooperative, Low back pain due to infective or neoplastic etiology were excluded. MR spine was performed and the findings were correlated with Modified Oswestry Disability Index. RESULTS Disc degenerative changes is common among 40 – 60 years age group. Females are more commonly affected than males. Central is the most type of disc bulge. L4-L5 is the most common level to be affected by disc bulge. Annulus fissure/ tear is most common in L4-L5 intervertebral disc level. Type I degenerative end plate changes are most common in L5-S1 intervertebral disc level. Whereas type II degenerative end plate changes are most common in L4-L5 intervertebral disc level. Facetal Arthropathy changes are common in L4-L5 levels both in grade I and II. Ligamentum flavum hypertrophy is common in L4-L5 level Spinal canal stenosis is common in L4-L5 levels both in grade I and II. Grade I neural foramen stenosis is common in L4-L5 and L5-S1 levels. Grade II, III and IV are common in L4-L5 intervertebral disc level. Oswestry disability score is higher in patients with severe spinal canal stenosis and neural foraminal narrowing. So, there is significant correlation xviii between spinal canal narrowing , neural foraminal narrowing and Modified oswestry disability index. So MODI score acts as an invaluable tool for assessing patients functional disability. Conclusion: MRI is a non-invasive modality. There is no risk of ionizing radiation hazard. MRI is better for the identification and grading the severity of lumbar degenerative disease. Subtle lesions can be identified in MRI. Modified oswestry disability index is a better tool for assessing patients functional disability.