A Study of Clinicoradiological Correlation of Prolapsed Intervertebral Disc in Lumbar Spine
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2018, Vol 6, Issue 9
Abstract
The diagnosis of disc herniation many a times becomes complex because one not only has to correlate clinical symptoms and signs with image findings but also has to determine which of anatomic abnormality is cause of the patient's pain.This study aims to determine the correlation between clinical features (pain distribution, neurological signs, and symptoms) and Magnetic resonance imaging (MRI) findings in lumbar disc prolapse and to know about its significance in decision making for treatment.Prospective study conducted between February 2014 to January 2016 at Department of Orthopedics, Mumbai Port Trust Hospital, and Mumbai. N= 52 patients. Allpatients selected were examined and their findings noted into pro forma. Details of pain projection in relation to specific dermatomes and muscles were noted. Straight leg raising test was performed. Visual Analogue Scores, Oswestry Disability Index, were clinical parameters used. Plain x rays of lumbosacral spine were taken and MRI spine was done for all patients. Disc herniation of types Protrusion, extrusion and sequestration were recorded by the radiologists using pro forma. All candidates for surgery were evaluated to assess fitness for anesthesia. Surgery was performed under general anesthesia.Maximum incidence of disc herniation was found in 4th and 5th decades (59.61%) with male to female ratio of 2:1. Manual laborer is more commonly affected. Back pain and sciatica are most common symptoms.L4-L5 was the commonest level of disc herniation. Sensory deficit was found to be significantly correlated with surgical findings. With multiple signs of single root compression offending disc herniation could be localized with higher accuracy. MRI scan has accuracy of 92.3% with false negativity of 20%. We found protrusion in 53.84% twenty eight patients, extrusion in sixteen patients (30.76%), sequestration and no disc in four patients each (7.7%) and incidence of far lateral herniation was 8 %.Sensory deficit was found to be significantly correlated with surgical findings. Decompression surgeries have good outcome. MRI is the standard imaging modality for detecting disc pathology due to its advantage of lack of radiation, multiplanar imaging capability, excellent spinal soft-tissue contrast and precise localization of intervertebral discs changes MRI is able to demonstrate accurately structural changes in disc, size and site of sequestrum or protrusion. However, these images are not useful in predicting neurological deficit, and therefore should not be used as indication for surgery unless there is strong correlation with the clinical findings. Clinical follow-up demonstrated no significant correlation with MRI images.
Authors and Affiliations
Dr. Gaurav Jain
Keywords
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