European Journal of Cardiovascular Medicine

strength, and support. Disc degeneration is a quite frequent issue that gets worse as people get older.  Among adults between the ages of 50 and 55, it varies by gender from 85% to 95% [1]. Typically asymptomatic, people with lumbar spine degenerative degeneration may or may not experience symptoms. Etiological factors include biochemical and inflammatory causes with compression of neuronal components, resulting in pain [2, 3]. Other determinants are age and sex, genetic inheritance, past physical stress, trauma, and poor nutrition [4].MRI, CT, and plain film imaging are the most often utilized modalities. The standard first imaging method for the lumbar spine is plain film examination . Current MRI techniques are effective for evaluating the neural foramen, spinal canal, ligaments, intervertebral disc, and vertebrae. In this study, patients who were referred to for MRIs because of LBP were assessed for anatomical cross-sectional changes, disco-graphic findings based on Modic Changes (MC) and Oswestry Disability index by 1.5 Tesla MRI. Subsequently, all the changes were studied in detail as given below.

DEPENDENT VARIABLE- OSWESTRY DISABILITY INDEX (ODI)

It is a questionnaire with ten sections, each with 6 statements. A value of 0 to 5 is allocated to every statement, based on thelevel of disability and suffering. The questionnaire assesses functional limitations related to lifting, personal care, sitting, walking, sleeping, standing, social life, sex life, & travel.

INDEPENDENT VARIABLES

Age and gender were examples of sociodemographic factors. For each patient, the following lumbar spine MRI characteristics were noted: neural foraminal narrowing, spinal canal narrowing, bulging, degree of narrowing, intervertebral disc desiccation, protrusion, and MC with reference to the region of maximum changes.

FIGURE 1-Intervertebral disc (IVD)

Patients with LBP were referred to our department for MRI from OPD/IPD of the Orthopedics department in Hind institute of medical sciences Barabanki

Singe Center, hospital-based cross-sectional descriptive study

Study Period: 18 months after obtaining approval from HIMS Ethics Committee.

Sample Size: 96, both sexes.

Sample technique: Continuous sampling

INCLUSION CRITERIA:

Patients of 40 years or above of both genders who complained of back pain &were referred for MRI evaluation for degenerative lumbar disc findings

EXCLUSION CRITERIA:

Patients with trauma, spinal tumor, infections, previous surgery and claustrophobia

METHOLOGY - 

Patients Fulfilling Above Criteria Were Examined Clinically & Their Modified Oswestry Disability Index &Visual Analogue Scale (Vas). After this MRI was done using 1.5 tesla PHILLIPS MRI Machine Following sequences were done- T2 SAGGITAL, CORONAL AND AXIAL. STIR SEQUENCES T1 SAGGITAL, CORONAL.

ASSESSMENT OF MRI FINDINGS:

Disc degeneration was evaluated for presence and severity using “Schneiderman et al. (40) criteria (Table 1), where higher scores denoted more severe disc degeneration.

TABLE-1: MRI PARAMETERS AND SCORESMODIC CHANGES –

It is an independent predictor of intense and disabling low back pain episodes in dorsolumbar spine.Vertebral end plate signal changes as a result of degeneration were graded as:

Modic Type 0 - normal disc and vertebral body appearance,

Modic type 1: low signal intensity on T1WI and high on T2WI, representing fibrovascular tissue, inflammatory changes and edema.

Modic type 2: high signal intensity on T1WI and isointense/high on T2WI, representing bone marrow replacement by fat.

Modic type 3: low signal intensity on both T1WI and T2WI, representing reactive sclerosis.

MODIFIED OSWESTRY LOW BACK DISABILITY QUESTIONNAIRE (ODI Q)

This questionnaire has been designed to give information as to how the back pain has affected patient’s ability to manage everyday life.

The Oswestry Disability Index Scoring-

The Oswestry Disability Index (aka the Oswestry Low Back Pain Disability Questionnaire) is an extremely important tool that researchers and disability evaluators use to measure a patient’s permanent functional disability. The test has been around since 1980 and is considered the ‘gold standard’ of low back pain functional outcome tools.

TABLE 2- MODIFIED OSWESTRY DISABILITY INDEX

Visual Analogue Scale (VAS):

Clinical measure the intensity or frequency of various symptoms. The pain VAS is a unidimensional measure of pain intensity, used to record patients’ pain progression, or compare pain severity between patients with similar conditions. VAS has also been widely used in diverse adult populations.

FIGURE 2

Data Management and Analysis:

Version 126.3 of SPSS software was employed to conduct the statistical analysis. To evaluate the inter-rater reliability of the radiographic evaluation of disc degeneration as well as other spinal abnormalities, kappa analysis was used.

Numerous variables were subjected to univariate analysis in connection to BMI, AGE, SEX, and VAS. The number of levels with disc space narrowing and the relationship between AGE/BMI/ODI categories and the degenerative disc disease score were evaluated using Tukey's posthoc pairwise correlation analysis.

The “study comprised 96 patients in all, 40 of whom were men and 56 of whom were women. The patients' average age was 46.9 ± 10.2 years. Male and female patients differed in age (p = 0.05). The median age of men was 49.8 ± 7.2 years, and the median age of women was 50.2±8.4” years. (Figure-3 Table 3)

TABLE 3: GENDER AND AGE-WISE DEMOGRAPHIC DISTRIBUTION OF PATIENTS:

Figure 3:  Gender and Age-wise distribution of patients:

Table 3& Figure-3, illustrated that the DLSD (Degenerative Lumber Spine Disease) was found more in the age group of 40-50 years, 52.5% in males and 55.35 in females. It was found significant (p=0.05).In the examined sample, female patients felt more pain. The median intensity of pain inwomen was 7, which was why they took pills every day. In men, on the other hand, themedian VAS was 6, and they took pills 3 times a week, which was significantly less compared to women (p < 0.05). In both sexes, back pain lasted 10 h a day (IQR = 15 h). The proportion of female patients (10.41%) having severe pain was significantly higher than the proportion of male patients (7.29%) (p = 0.05).

Figure 4 illustrates that the pain intensity due to DLSD was found more in females as compared to males. Moderate pain intensity (5-7) as per VAS score was observed at 33.33% in females whereas, it was 26.04% in males.  (p=0.05)

FIGURE 5 demonstrated that the female patients ( 32.29%) were taking more painkillers (5-7/ week) as compared to males (25%). it was found significant (p=0.037).

The frequency of the different ODI degrees and the levels of pain in the VAS were illustrated in Figures 22-24. In total, 8.24% of the patients had minimal disability in the ODI; 37.65%, moderate disability; 32.94%, severe disability; 20%.

FIGURE 6

          FIGURE 7

FIGURE 8 

  Modic change was present in 21 (21.87%) in our study. Type II Modic change was the

 predominant type accounting for 71.42% (15 out of the 21). L3–L4 (16.83%) segment was

  the most frequently involved followed by L2/3 (5/18) and L4/5 (6/20).

FIGURE 9

TABLE 4

FIGURE 10

            TABLE 5

TABLE 6

This study attempted to ascertain the relationship between the and “the pattern of MRI abnormalities in adult patients with degenerative disc changes (7). The two most prevalent MRI patterns found were disc bulging and foraminal stenosis, both of which were shown to be more common in the current study than in earlier studies. While foraminal stenosis and other discal MRI parameters demonstrated a substantial correlation with the degree of disability, the grade of spinal canal stenosis exhibited a poor correlation with the ODI score. When predicting the level of clinical disability in patients with degenerative disc, MRI is not very useful on its own. For this reason, it is best used in conjunction with the ODI score, especially in settings with limited resources. Future research should be done with a bigger sample of patients of both genders who require the usage of various treatment and diagnostic methods. The study's patient cohort was small but robust enough because just one radiologist, the author—was involved in the data analysis, ensuring data consistency. (8)  While these restrictions were taken into consideration when interpreting our findings, it was also suggested that routine MRIs with ODI be performed, especially in rural populations.

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