European Journal of Cardiovascular Medicine

Chronic low back pain (CLBP) is one of the most prevalent and disabling musculoskeletal disorders globally, with an estimated lifetime prevalence of up to 80% [1]. It significantly affects quality of life, functional capacity, and healthcare expenditure, often leading to recurrent medical consultations and productivity loss [2]. CLBP is defined as pain localized to the lower back region that persists for more than 12 weeks and may or may not be accompanied by radicular symptoms.

The etiology of CLBP is multifactorial, involving degenerative disc disease, facet joint arthropathy, disc bulge or herniation, spinal canal or foraminal stenosis, spondylolisthesis, and in some cases, non-structural causes such as myofascial pain or psychosomatic components [3,4]. Identifying the underlying cause is essential for appropriate therapeutic interventions and prognostication.

Magnetic Resonance Imaging (MRI) remains the imaging modality of choice for evaluating CLBP due to its superior soft tissue resolution and ability to visualize intervertebral discs, spinal cord, nerve roots, and surrounding structures without ionizing radiation [5]. It is particularly indicated in patients with persistent pain, neurological deficits, or suspected serious pathology such as malignancy or infection [3].

However, the relationship between MRI findings and clinical symptoms in CLBP patients remains inconsistent. Several studies have shown that degenerative changes, though frequently detected on MRI, may also be present in asymptomatic individuals, raising concerns about potential overuse and overinterpretation of imaging [1,2,6]. This underscores the importance of correlating imaging findings with clinical evaluation to avoid unnecessary interventions.

This study aims to retrospectively analyze the spectrum of MRI findings in patients presenting with chronic low back pain and to evaluate the correlation between radiological abnormalities and clinical presentations, thereby aiding in the rational interpretation of MRI results in routine practice.

Study Design and Setting:
This was a retrospective observational study conducted at the Department of Radiology, Osmania Medical College, Hyderabad, over a period of eight months, from August 2024 to March 2025.

Study Population:
The study included 100 adult patients (aged 20–70 years) who presented with chronic low back pain of more than 12 weeks’ duration and underwent lumbar spine MRI during the study period. Patients were referred from outpatient departments including orthopedics, neurology, and general medicine.

Inclusion Criteria:

Patients aged between 20 and 70 years.

Chronic low back pain lasting for more than 12 weeks.

Availability of complete clinical records and lumbar spine MRI reports.

Exclusion Criteria:

History of spinal trauma or spinal surgery.

Known malignancy, infection (e.g., tuberculosis), or congenital spinal deformities.

Incomplete medical or radiological records.

Data Collection:
Patient data were collected retrospectively from medical records and radiology archives. Demographic details, clinical symptoms (e.g., radiculopathy, mechanical back pain), and MRI findings were recorded. MRI scans were performed using a 1.5 Tesla scanner and evaluated by experienced radiologists. Findings such as disc degeneration, bulge, herniation, spinal canal or foraminal stenosis, Modic changes, facet joint arthropathy, and spondylolisthesis were noted.

Statistical Analysis:
Data were entered into Microsoft Excel and analyzed using SPSS version 25. Descriptive statistics were used to summarize demographic and MRI findings. Associations between clinical symptoms and MRI abnormalities were tested using Chi-square test or Fisher’s exact test as appropriate. A p-value < 0.05 was considered statistically significant.

Ethical Considerations:
Necessary permissions were obtained prior to the commencement of the study. Patient confidentiality was strictly maintained throughout the data collection and analysis.

A total of 100 patients presenting with chronic low back pain were included in this retrospective analysis. The mean age of participants was 45.7 ± 12.4 years, with a male predominance (55 males and 45 females), as shown in Table 1.

Table 1: Demographic Profile of Study Participants (n = 100)

MRI evaluation revealed that degenerative disc disease was the most prevalent finding, observed in 78% of the participants, followed by disc bulge (62%), disc herniation (41%), and spinal canal stenosis (36%). Less common findings included facet joint arthropathy (30%), Modic changes (24%), foraminal stenosis (27%), spondylolisthesis (12%), and annular tear (9%). Notably, 8% of patients had no significant abnormalities on MRI (Table 2).

Table 2: MRI Findings Among Patients with Chronic Low Back Pain

Figure 1. MRI Findings Among Patients with Chronic Low Back Pain

The L4–L5 intervertebral level was the most commonly affected, demonstrating degenerative changes in 65% of patients, followed by the L5–S1 (53%) and L3–L4 (28%) levels (Table 3).

Table 3: Level-wise Distribution of Degenerative Changes

Figure 2.  Level-wise Distribution of Degenerative Changes

Clinical correlation analysis showed that radiculopathy was significantly associated with findings of disc herniation and foraminal stenosis (p < 0.01), while patients with mechanical low back pain without radicular features most commonly exhibited degenerative disc disease and facet joint arthropathy (p < 0.05). Among the 8 patients with normal MRI findings, symptoms were likely of myofascial or non-structural origin (Table 4).

Table 4: Clinical Correlation Between Symptoms and MRI Findings

Chronic low back pain (CLBP) continues to be a major public health challenge due to its high prevalence, tendency for recurrence, and associated socioeconomic impact. In this retrospective study conducted over eight months at Osmania Medical College, Hyderabad, we analyzed lumbar spine MRI findings in 100 patients with CLBP and examined their correlation with clinical presentations.

Degenerative disc disease (DDD) was the most common MRI abnormality, found in 78% of patients, followed by disc bulge (62%) and disc herniation (41%). These findings are in line with prior studies that confirm the high prevalence of degenerative changes in both symptomatic and asymptomatic populations [8,9]. The L4–L5 and L5–S1 levels were most frequently affected, consistent with their biomechanical susceptibility due to increased mobility and load transmission [10].

A significant correlation was observed between radiculopathy and MRI findings such as disc herniation and foraminal stenosis (p < 0.01), supporting the role of nerve root compression in the pathogenesis of radiating pain [7]. In contrast, patients presenting with mechanical low back pain without radicular symptoms more frequently exhibited DDD and facet joint arthropathy (p < 0.05), suggesting the involvement of structural yet non-compressive pain generators such as annular tears and facet joint degeneration [9,11].

Interestingly, 8% of patients demonstrated normal MRI findings despite persistent symptoms, highlighting the multifactorial etiology of CLBP. Non-structural causes such as myofascial dysfunction, psychosocial stressors, or central sensitization may underlie these cases. This observation reinforces the importance of clinical correlation and the limitations of imaging alone in the evaluation of CLBP [8,12].

While MRI remains an invaluable diagnostic modality for detecting structural abnormalities, its findings should not be interpreted in isolation. Over-reliance on MRI without appropriate clinical context may lead to overdiagnosis, patient anxiety, and even unnecessary interventions, particularly in healthcare settings with high imaging accessibility [11,12]. A balanced, symptom-guided approach is essential to optimize patient outcomes and avoid iatrogenic harm.

Limitations of our study include its retrospective design, relatively small sample size, and single-center setting. Future prospective studies with larger populations and inclusion of functional outcome measures may provide more definitive insights.

This retrospective study highlights the significant prevalence of degenerative changes on MRI among patients with chronic low back pain, with degenerative disc disease, disc bulge, and herniation being the most common findings. The L4–L5 and L5–S1 levels were most frequently affected. A statistically significant correlation was observed between disc herniation and radicular symptoms, and between disc degeneration/facet arthropathy and mechanical low back pain. However, a subset of patients had normal MRI despite persistent symptoms, emphasizing the importance of clinical correlation. MRI remains a valuable diagnostic tool, but interpretation must consider patient history and examination to guide effective and individualized treatment strategies for chronic low back pain.

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