European Journal of Cardiovascular Medicine

lower back ache (LBA) represents a pervasive clinical and public health concern, affecting a substantial portion of the global population and imposing a significant socioeconomic burden on healthcare systems worldwide [1]. It is estimated that approximately 70–80% of individuals will experience back pain at some point during their lifetimes, with a noteworthy proportion requiring medical intervention and/or prolonged periods of rehabilitation [1]. Among the various etiologies of LBA, lower back ache  (LBA) secondary to degenerative spine disorders is remarkably common, particularly in regions where sedentary lifestyles, occupational hazards, or genetic predispositions contribute to the early onset of spinal changes [2-4]. The spectrum of causes underlying LBA includes degenerative alterations in spinal structures (disc desiccation, disc prolapse, facet arthropathy), neoplasms, infections (such as spinal tuberculosis), traumatic injuries, and inflammatory conditions or arthropathies [5]. Collectively, LBA stands out as the primary cause of physical disability in industrialized nations, especially among individuals in their fourth decade of life and beyond. Unsurprisingly, it also ranks as the second most prevalent reason for seeking a physician’s consultation, surpassed only by upper respiratory tract infections [6-8].

In addition to its high prevalence, LBA frequently manifests as one of the chief causes of occupational absenteeism, reflecting its broader impact on workforce productivity and quality of life [9, 10]. A common culprit in many patients presenting with acute or chronic LBA is intervertebral disc prolapse (often labeled herniation), especially in the lumbar region, where the highest mechanical load and rotational stress converge. Though mild degenerative changes of the spine naturally occur during aging, they are considered pathological only when they provoke clinical symptoms and objective signs, thereby signifying an abnormal compromise of spinal structures [11, 12]. Multiple components of the lumbar spine can contribute to LBA, including the intervertebral discs, vertebral periosteum, facet joints, and spinal ligaments, all of which are susceptible to age-related or stress-induced degeneration. Often, lumbar radiculopathy—one of the most frequent conditions encountered by spine specialists—emerges from compressive or irritative lesions on the nerve roots, leading to radicular pain and neurological deficits. Men and women are both affected, although men may manifest symptoms as early as their fourth decade, while women often experience them in their fifth to sixth decades [11, 12]. Degenerative spondyloarthropathies are overwhelmingly cited as the primary cause of lumbar radiculopathy, with aging recognized as a significant risk factor given the cumulative degenerative processes that unfold over time.

A further entity that warrants particular attention in the degenerative cascade is lumbar spinal stenosis, which is associated with a progressive constriction of the spinal canal, lateral recesses, or neural foramina [13]. Spinal stenosis may be classified as congenital (resulting from inborn narrow canals) or acquired (commonly due to osteophytic overgrowths, hypertrophy of the ligamentum flavum, and facet joint arthrosis). Compression of the lumbosacral nerve roots, whether by bony or soft tissue structures, can elicit a constellation of symptoms ranging from axial lower back ache to radicular pain, and in severe cases, cauda equina syndrome [13]. While conservative measures such as physical therapy, pharmacological pain management, and epidural injections serve as first-line treatments, surgical interventions may become imperative if progressive neurological deficits ensue or if conservative approaches fail to abate symptoms. One intriguing aspect of lumbar disc pathology is the variability in clinical presentation: the same magnitude of disc herniation may produce severe radiculopathy in some individuals yet remain relatively asymptomatic in others, underscoring the multifactorial nature of pain perception and nerve root compromise. In this regard, correlating imaging findings with clinical manifestations is paramount, as it can clarify the precise anatomical sources of pain and optimize patient-specific treatment strategies [14].

Magnetic Resonance Imaging (MRI) has significantly transformed the diagnostic approach to spinal disorders. Owing to its superior soft tissue contrast resolution, MRI allows detailed visualization of intervertebral discs, nerve roots, spinal ligaments, epidural fat, paraspinal musculature, and bone marrow changes without subjecting patients to ionizing radiation [15]. In evaluating suspected degenerative conditions of the spine, the ability to acquire multiplanar images—most notably sagittal and axial views—facilitates a more holistic understanding of pathological changes. These may include disc desiccation (reduced T2 signal), loss of disc height, annular fissures, disc bulges or focal herniations, ligamentum flavum hypertrophy, osteophyte formation, and various forms of spinal stenosis. MRI has been demonstrated to be at least as accurate as CT myelography for delineating the morphological changes in the spinal canal, and indeed, it often surpasses older imaging techniques such as myelography and standalone CT in diagnostic precision [15]. Nevertheless, cautious interpretation is crucial. For instance, sclerotic osteophytes that appear as areas of low signal intensity on T2-weighted images may lead to an overestimation of canal stenosis if not clinically correlated. Furthermore, the phenomenon of incidental findings—where asymptomatic patients may exhibit significant degenerative changes on MRI—complicates diagnostic algorithms [16]. Consequently, the physician must converge the clinical picture (history, physical examination, and specific provocative tests) with imaging evidence to ascertain whether a particular abnormality is indeed the pain generator. This issue is further underscored by the broad term “degeneration,” which in spinal MRI encompasses a plethora of imaging characteristics, including disc dehydration, decreased disc cavity height, multi-planar disc bulging or prolapse, annular tears, degenerative endplate changes, sclerosis, and osteophytic overgrowth [17].

In recent years, continued advancements in MRI technology—such as higher field strengths (3.0T and above), improved coil designs, and refined software algorithms—have allowed even more nuanced interrogation of spinal structures [18]. Such progress enables radiologists to detect subtler disc protrusions, better characterize annular fissures, and identify small nerve root compressions, all of which can have a profound impact on patient management. Given the central role of MRI, it has now become a routine investigation for patients suspected of having significant degenerative lumbar disorders, and it is widely regarded as the gold standard for diagnosing disc herniations [18]. On MRI, these herniations commonly appear as focal outpouchings of the disc margin, often accompanied by a corresponding decrease in T2 signal intensity within the nucleus pulposus or evidence of annular disruption. Additional indicators of degenerative spinal disease include air lucencies within the disc (vacuum phenomenon), calcifications, marginal osteophytes, vertebral endplate irregularities, bone marrow signal alterations, and ligamentum flavum hypertrophy. The resultant canal or foraminal compromise can vary from mild to severe, which explains the broad variability in clinical symptoms and signs [19, 20].

One of the enduring challenges for clinicians and radiologists alike is the occasional mismatch between MRI findings and the patient’s clinical presentation. It is not uncommon for a patient with severe degenerative changes or large disc herniations on MRI to report minimal pain or disability, while another individual with relatively modest radiologic abnormalities may describe debilitating symptoms [19. 20]. In these scenarios, the radiologist plays a pivotal role in carefully synthesizing imaging data with the clinical context provided by physicians and surgeons. This integrative approach can help identify the structural anomalies most likely accountable for the patient’s pain and guide targeted interventions (e.g., precise nerve root blocks, selective surgical decompression, or rehabilitative strategies).

Accordingly, the overarching aim of this post-doctoral research is to delineate the degree of concordance between MRI evidence of degenerative lumbar pathology and the clinical manifestations observed in patients with LBA. By employing standardized reporting protocols for MRI findings, coupled with meticulous clinical examinations and validated outcome measures, this study aspires to clarify the prognostic significance of various degenerative markers—particularly disc protrusions, annular fissures, and spinal stenosis parameters—in predicting patient outcomes and guiding clinical decision-making. Such insights stand to optimize patient care by reducing diagnostic uncertainty, minimizing unnecessary treatments, and channeling resources toward the most appropriate and efficacious interventions for individuals suffering from degenerative spine disease. Ultimately, better alignment between radiological discoveries and clinical findings could enhance diagnostic accuracy, streamline therapeutic plans, and lessen the overall burden of LBA on both the individual and society at large. With MRI established as a cornerstone of contemporary spinal imaging, it is hoped that the results of this investigation will not only reinforce its role but also refine its usage as an indispensable tool for unraveling the intricate interplay of structural and symptomatic factors in LBA.

Aims and Objective

The study aims to determine the correlation between MRI-detected disc pathology and clinical presentations of radiculopathy in patients with Lower back ache. Its objective is to identify MRI markers predictive of neurological deficits, enhancing diagnostic accuracy and guiding targeted interventions for improved patient 

Study Design

This observational cross-sectional study was conducted to examine the relationship between MRI findings and clinical evaluations in patients with Lower back ache and radiculopathy. Seventy participants, aged 18–65, presenting with symptoms were enrolled from the Orthopaedics OPD at ESI-PGIMSR, New Delhi, between November 2020 and April 2022. Each patient underwent a comprehensive clinical examination, including sensory testing and Straight Leg Raising (SLR) assessments, alongside detailed MRI scans of the lumbar spine. The study design prioritized systematic data collection and ensured consistency in imaging protocols and clinical evaluations to establish clear correlations between radiological evidence and patient-reported symptoms.

Inclusion Criteria

Participants eligible for inclusion were adults aged 18–65 years presenting with Lower back ache and clinical signs of radiculopathy. Specific criteria required the presence of radiating pain into one or both lower limbs, positive neurological findings on physical examination (such as reduced SLR or sensory loss), and willingness to undergo MRI evaluation. Candidates had to consent voluntarily after being informed about the study's scope, procedures, potential risks, and benefits. These criteria ensured a homogeneous study population for accurately assessing the relationship between MRI results and clinical features of radiculopathy.

Exclusion Criteria

Patients were excluded if they had undergone lower back surgery within the past year, exhibited signs of cauda equina syndrome, or had a known or suspected spinal tumor. Further exclusion applied to those with contraindications to MRI, such as pregnancy, presence of metal implants, pacemakers, or known allergies to contrast media. Such conditions could confound MRI interpretation or pose additional risks to participants. Excluding these factors maintained study integrity and ensured the safety of participants while focusing on primary degenerative spinal pathologies.

Data Collection

Data were collected through structured clinical examinations and standardized MRI protocols. Clinical data included patient history, neurological assessments (SLR, sensory tests), and symptom duration. MRI scans evaluated disc herniations, canal stenosis, and nerve compression levels. Information was systematically recorded using pre-designed forms to ensure consistency and accuracy. All imaging interpretations were conducted by experienced radiologists, and clinical evaluations were performed by trained physicians to minimize observer bias and enhance data reliability.

Data Analysis

Collected data were entered into SPSS version 26.0 for comprehensive statistical analysis. Descriptive statistics summarized demographic and clinical characteristics, presenting means, standard deviations, and frequency distributions. Chi-square tests were employed to assess associations between categorical variables, such as MRI findings and clinical symptoms. Odds ratios with 95% confidence intervals were calculated to determine the strength of associations. A p-value of <0.05 was considered statistically significant. Multivariate analysis was performed to adjust for potential confounders, enhancing the robustness of findings. The analysis aimed to validate correlations between MRI indicators—like disc sequestration, stenosis, and neural compression—and clinical outcomes reliably.

Ethical Considerations

Ethical approval was obtained from the Institutional Ethical Committee of ESI-PGIMSR before initiating the study. All participants provided written informed consent after receiving comprehensive information about the study's objectives, procedures, potential risks, and benefits. Confidentiality of patient data was strictly maintained, with records anonymized to ensure privacy. The study adhered to the Declaration of Helsinki principles, ensuring participant safety and ethical integrity throughout research processes. No procedures posed additional risks to subjects, their families, or staff, affirming ethical conduct.

The study was conducted among 70 patients (18 to 65 years old) who presented with lower backache and having radiculopathy in orthopaedics OPD. Mean age of the study participants was 45.96 (+ 12.97 years).

Table 1: Age Distribution Among the Study Participants

Figure 1: Age (In Years) Distribution Among the Study Participants

Table 1 (Figure 1) shows age distribution of the study participants. The age of the study participants raged between 28 to 78 years. 27.1% of the study participants belonged to the age group of 26-35 years. 28.6% were in the age group of 36-45 years. 15.7% and 20% belonged to the group of 46-55 years and 56-65 years, respectively.

Table 2: Sex Distribution of the Study Participants

Figure 2: Sex Distribution of The Study Participants

Table 2 (Figure 2) shows sex distribution of the study participants. Out of 70 participants, 34(48.6%) of the participants were male and 36(51.4%) were females.

Table 3: Distribution of Radiculopathy Among Study Participants

Figure 3: Distribution Of Radiculopathy Among Study Participants

Table 3 (Figure 3) shows distribution of lower limb radiculopathy among the study participants. Bilateral lower limb radiculopathy was seen in 20 (28.6%) participants whereas, other had unilateral lower limb radiculopathy. Out of 50(71.4%) participants which have unilateral radiculopathy, left side radiculopathy was seen in 38(76%) individuals whereas right side radiculopathy was seen in 12(24%).

Table 4: Pain Distribution Among the Study Participants as Per Dermatome

Figure 4: Pain Distribution Among the Study Participants as Per Dermatome

Table 4 (Figure 4) shows pain distribution among the study participants as per dermatomal level. Most common dermatomal level involved was L5 (34.3%) and S1 (34.3%), followed by L4 (11.4%), L4-L5 (7.1%) and L5-S1 (5.7%). Other dermatomal regions involved included, L3 (2.9%), L3-L4, L5-S1 (2.9%), and L4-L5, L5-S1 (1.4%)

Table 5: Distribution of the Study Participants According to the Response to Straight Leg Raising Test (SLR)

Figure 5: Distribution of the Study Participants According to the Response to Straight Leg Raising Test (SLR)

Table 5 (Figure 5) shows distribution of the study participants according to the response to straight leg raising test (SLR). SLR was found to be decreased 14 participants on right side and 19 participants on the left side.

Table 6: Distribution of the Study Participants According to the Sensory Loss

Figure 6: Distribution of the Study Participants According to the Sensory Loss

Table 6 (Figure 6) shows distribution of the study participants according to the dermatomal sensory loss. Sensory loss was present in 29 (41.4%), whereas there was no sensory loss in 41 (58.6%).

Table 7: Distribution of Study Participants According to the Type of Disc Herniation

Figure 7: Distribution of Study Participants According to The Type of Disc Herniation

Table 7(Figure 7) shows distribution of study participants according to the type of disc herniation. Majority of the participants had disc bulge (78.5%), followed by disc protrusion (22.8%), disc sequestration (15.7%) and disc extrusion (12.8%).

Table 8: Distribution of Study Participants According to Level of Disc Bulge

Table 8 shows distribution of study participants according to level of disc bulge. Central bulge at L4-L5 and L5-S1 was observed among nearly one-fifth of the study participants. Other commonly involved levels observed were central bulge at L3-L4, L4-L5 and L5-S1 (9), followed by central bulge at L4-L5 (8) and L5-S1 (6).

Table 9: Distribution of Study Participants According to Level of Disc Protrusion

Figure 8: Distribution of Study Participants According to Level of Disc Protrusion

Table 9(Figure 8) shows distribution of study participants according to level of disc protrusion. Central disc protrusion was commonly observed at L4-L5 (5) level and L5-S1 (3) level.

Table 10: Distribution of Study Participants According to Level of Disc Extrusion

Figure 9: Distribution of Study Participants According to Level of Disc Extrusion

Table 10(Figure 9) shows distribution of study participants according to level of disc extrusion. Paracentral disc extrusion was commonly observed at L4-L5, L5-S1 (2) level and L5-S1 (2) level.

Table 11: Distribution of Study Participants According to Level of Disc Sequestration

Figure 10: Distribution Of Study Participants According to Level Of Disc Sequestration

Table 11 (Figure 10) shows distribution of study participants according to level of disc sequestration. Paracentral disc sequestration was commonly observed at L4-L5 (5) level and L5-S1 (2) level.

Table 12: Distribution of Study Participants According to Level and Grade of Disc Degeneration

Table 12 shows distribution of study participants according to level and grade of disc degeneration. Grade 1 degeneration was reported at the level of L4-L5 (1) and L5-S1 (1). Grade 2 level was seen at three levels including L4-L5 (5), L5-S1 (4) and L4-L5, L5-S1 (4). Grade 3 level of degeneration was also seen at three levels including L4-L5 (1), L5-S1 (2), and L3-L4 (1). Grade 4 level of disc degeneration was seen at multiple levels including L4-L5 (7), L5-S1 (4), L4-L5, L5-S1 (16), L3-L4 (1) and L3-L4, L4-L5, L5-S1 (1). Grade 5 level of degeneration was also seen at five levels including L4-L5 (2), L5-S1 (2), L4-L5, L5-S1 (4) and L3-L4, L4-L5 (2).

Table 13: Distribution of Study Participants According to Presence of Central Canal Stenosis

Figure 11: Distribution of Study Participants According to Presence of Central Canal Stenosis

Table 13 (Figure 11) shows distribution of study participants according to presence of central canal stenosis. Central canal stenosis was defined as, canal diameter of less than 10 mm. Central canal stenosis was reported among 77.1% (54) of the study participants.

Table 14:  Distribution of Study Participants According to Laterality of Lower Limb Radiculopathy and Nerve Compression

Table 14 shows distribution of study participants according to laterality of lower limb radiculopathy and nerve compression. In participants having Right side lower limb radiculopathy, right nerve compression was seen in 4 (33.3%), no compression of nerve in 4 (33.3%), left nerve compression in 1 (8.4%) and both side nerve compression in 3 (25.0%). In participants having Left side lower limb radiculopathy, no compression was seen in 17 (44.7%), both side nerve compression in 11 (28.9%), left side nerve compression in 7 (18.5%) and right-side nerve compression in 3 (7.9%). In patients having bilateral lower limb radiculopathy, both side nerve compression was seen in 12 (60.0%) and no compression in 3 (15.0%).

Table 15: Correlation Between MRI Disc Level and Dermatomal Level

Table 15shows correlation between MRI disc level and dermatomal level. Disc involvement at L4-L5, L5-S1 level which produced radiculopathy at S1 level was reported among 12 participants. Disc involvement at L4-L5, L5-S1 Level producing L5 radiculopathy was observed among 8 study participants. Six participants were reported to have S1 radiculopathy with disc involvement at L5-S1 level. Five participants were reported to have L5 radiculopathy with disc involvement at L4-L5 level.

Table 16: Distribution of Study Participants According to Type of Disc Herniation and Neural Canal Compromise

Table 16 shows distribution of study participants according to type of disc herniation and neural canal compromise. Out of 55 participants who had disc bulge, 74.5% and 70.9% had neural foramen stenosis and nerve root compression, respectively. Out of 16 participants who had disc protrusion, 14 and seven had neural foramen stenosis and nerve root compression, respectively. All nine participants who had disc extrusion, also had neural foramen stenosis, whereas root compression was seen among 66.6% of the study participants. All 11 participants who had disc sequestration, also had neural foramen stenosis and nerve root compression.

Table 17. Association Between Neurological Deficit and MRI Findings

Table 17 shows association of neurological deficit with MRI findings among the study participants. The odds of neurological deficit were higher among those with abnormal MRI findings. Although, it was statistically significant for disc sequestration (OR:0.06; 95% CI: 0.008-0.57), foramen narrowing (OR:0.23; 95% CI: 0.06-0.82) and canal stenosis (OR:0.09; 95% CI: 0.02-0.32).

The prevalence of lower back ache (LBA) with radiculopathy continues to rise globally, concomitant with an aging population and increased access to medical diagnostics such as MRI. This study aimed to correlate MRI findings with clinical evaluations in patients suffering from Lower back ache with radiculopathy, thereby enhancing understanding of pathoanatomical changes, guiding patient management, and aligning with contemporary diagnostic standards. The results of our study are compared with existing literature to delineate both congruences and disparities, offering insights into the complex relationship between radiological findings and clinical manifestations.

Epidemiology and Demographics

Our study involved 70 patients with a nearly equal distribution of females (51.4%) and males (48.6%), with a mean age of 45.96 ± 12.97 years. There was no significant gender predisposition observed, which aligns with certain previous research studies that report similar gender distribution patterns [21]. However, some literature indicates a male predominance in LBA cases, attributing it to increased involvement in physically strenuous and outdoor activities. Tawa et al., in contrast, reported a female predominance, potentially due to varied occupational and lifestyle factors influencing back pain prevalence [22]. The variation in gender distribution across studies may reflect sociocultural and occupational differences, as well as differential pain-reporting behaviors between genders. The age distribution in our cohort revealed a substantial proportion of patients in the 26–45 age bracket, with 27.1% falling in the 26–35 range and 28.6% in the 36–45 range. This finding resonates with Janardhan et al.’s study, which also reported a similar mean age for patients presenting with radiculopathy [23]. Increased mechanical stress, sedentary lifestyles, and degenerative changes accumulating with age contribute to the higher incidence of LBA in this demographic. Notably, though degenerative disc changes become more prevalent in older populations, the peak clinical presentation often emerges in middle age, which is consistent with our observations and widely reported in the literature.

Clinical Presentation and Correlation with Radiculopathy

Our study found that 71.4% of patients presented with unilateral radiculopathy, predominantly on the left side (76% of unilateral cases), while 28.6% had bilateral radiculopathy. This observation is in concordance with the findings of Safa Yousif et al., who also reported a higher incidence of unilateral radiculopathy [24]. The predominance of unilateral symptoms might be explained by the asymmetrical nature of disc degeneration or localized disc herniations more commonly affecting one side due to anatomical variances in the spine and mechanical loading patterns. In terms of dermatomal distribution, the L5 and S1 dermatomes were most frequently involved, each accounting for 34.3% of cases. This finding correlates strongly with Janardhan et al., who reported similar frequency patterns for these levels [23]. The L5 and S1 nerve roots are most commonly affected due to their anatomical predisposition at the L4-L5 and L5-S1 levels, which bear significant biomechanical loads and are therefore susceptible to degenerative processes. The high proportion of radiculopathy at these levels underscores the importance of careful clinical evaluation when these dermatomes are implicated.

The Straight Leg Raising (SLR) test, a key physical examination maneuver used to detect nerve root irritation, was decreased in 20% of patients on the right side and 27.1% on the left side. This test's sensitivity in detecting sciatica and radicular pain has been well-documented. Our observed SLR reduction rates align with typical clinical practice, where a positive SLR often corroborates MRI findings of disc herniation and nerve root compression.

MRI Findings and their Clinical Correlations

Disc pathology was prevalent in our study group, with disc bulge being the most common finding (78.5%), followed by disc protrusion (22.8%), extrusion (12.8%), and sequestration (15.7%). These findings echo existing literature, indicating disc bulges are ubiquitous in patients presenting with LBA but may not always correlate with symptoms [21, 22]. MRI has been a valuable tool in this domain because it provides a detailed evaluation of soft tissue structures, facilitating the identification of disc bulges, protrusions, and more severe pathologies like extrusions and sequestrations. The high frequency of disc bulges supports previous studies suggesting that while disc bulges are common in symptomatic patients, their clinical significance is often questionable unless accompanied by neural compromise. Our evaluation of neural foraminal narrowing and nerve root compression is critical, as these features directly correlate with radiculopathy. Notably, in our study, most symptomatic patients exhibited neural foraminal compromise, especially in cases with paracentral disc herniations. We observed that central disc herniations, which do not impinge on the neural foramen, were less likely to cause significant clinical symptoms compared to paracentral or lateral lesions that directly compress nerve roots. This observation is consistent with studies by Janardhan et al. and others, which emphasize the role of lesion location in determining symptom severity [23].

Comparison with Other Studies on Disc Level Correlation

Our findings indicated that disc prolapses at the L4-L5 level were responsible not only for typical L5 radiculopathy but also, in some cases, caused L4 and S1 radiculopathy. Similarly, L5-S1 disc prolapses, predominantly causing S1 radiculopathy, were occasionally associated with L5 radiculopathy. This complexity reflects the multifaceted nature of disc pathology, where a single disc herniation may influence multiple nerve roots depending on its size, location, and the individual’s anatomical variations. Comparatively, Janardhan et al. reported that L4-L5 disc prolapse predominantly causes L5 radiculopathy, but also noted occasional involvement of adjacent nerve roots [23]. Our observation of multiroot involvement may be attributed to larger or more complex herniations that extend beyond the typical boundaries of nerve root exit foramina. Studies by Safa Yousif et al. and Boden et al. also emphasize that while there are common patterns, variability in clinical presentations can occur, requiring careful interpretation of MRI in conjunction with clinical findings [24, 25].

Degenerative Changes and Multilevel Involvement

In our study, 80% of patients demonstrated degenerative changes at multiple spinal levels, predominantly at L4-L5 and L5-S1. This high prevalence of multilevel degeneration is well-documented in the literature. A similar study identified that disc degeneration is often widespread, with a significant number of individuals showing multilevel involvement even in asymptomatic populations. Our findings bolster these observations, emphasizing that degeneration is not confined to a single disc but often spans adjacent intervertebral discs due to contiguous biomechanical stress. Furthermore, Rai GS et al. discussed that multilevel degeneration could be associated with a higher incidence of neural foraminal compromise and spinal canal stenosis, leading to more pronounced clinical symptoms such as radiculopathy and neurogenic claudication [26]. Our study supports this by demonstrating a high rate of central canal stenosis (77.1%) among patients, a condition likely stemming from widespread degenerative changes contributing to ligamentous hypertrophy, facet joint arthropathy, and osteophyte formation.

Correlation Between MRI and Clinical Findings

One of the salient outcomes of our study is the correlation between MRI findings and clinical examination in patients with radiculopathy. Although not all abnormal MRI findings correlated with clinical symptoms, a substantial proportion did. For instance, patients exhibiting neural foraminal narrowing and nerve root compression on MRI often reported corresponding dermatomal pain and neurological deficits. This alignment suggests that, while MRI is highly sensitive in detecting structural abnormalities, its findings must be interpreted in the context of a thorough clinical examination. Numerous studies have highlighted the potential mismatch between imaging and symptoms, noting that asymptomatic individuals can also exhibit significant degenerative changes on MRI. However, our study underscored that the presence of neural foraminal compromise, particularly in the context of disc extrusion, protrusion, or sequestration, increases the likelihood of symptomatic radiculopathy. For instance, disc sequestration showed a strong association with neurological deficits, with an odds ratio (OR) of 0.06 (p=0.01), indicating a statistically significant predictor of clinical impairment. Similarly, foraminal narrowing and canal compression had ORs of 0.23 and 0.09 respectively, with significant p-values (<0.05 and <0.001), reinforcing their clinical relevance.

Comparative Analysis with Prior Research

Our study's results correlate well with the literature regarding the predictive value of specific MRI findings. Janardhan et al. found that disc herniations causing nerve root compression frequently resulted in radiculopathy and that the anatomical relationship between herniation and nerve root was crucial in determining symptomatology [23]. The correlation between paracentral disc herniation and radiculopathy found in our study corroborates these insights, as paracentral lesions are more likely to impinge on nerve roots within the lateral recess or foramen. Other studies, such as those by Beattie et al., have emphasized that root compression is associated with severe distal leg pain and neurological deficits, which our findings echo [27]. We observed that disc extrusions and sequestrations causing foraminal narrowing were strongly associated with nerve root compression and consequent radiculopathy. These results emphasize the importance of not only identifying the presence of a disc herniation but also detailing its position relative to neural structures. Furthermore, our findings on the distribution of radiculopathy—primarily affecting the L5 and S1 dermatomes—are consistent with large-scale epidemiological studies. For instance, Safa Yousif et al. reported a high incidence of L5/S1 radiculopathies among patients with disc herniations at corresponding levels [24]. These correlations are significant, as they provide a framework for clinicians to predict symptom patterns based on MRI findings, thereby enhancing the diagnostic process and informing treatment strategies.

Implications for Clinical Practice

The integration of MRI findings with detailed neurological examination is crucial for optimal management of patients with LBA and radiculopathy. Our study reinforces the notion that while MRI is the gold standard for imaging spinal pathology, its findings should not be interpreted in isolation. The strong correlation we observed between neural foraminal compromise and clinical symptoms suggests that clinicians can rely on a combination of MRI and clinical evaluation to predict the severity of radiculopathy. In practice, a positive correlation between imaging and symptoms can guide decision-making regarding conservative management versus surgical intervention. Our findings also highlight the need for meticulous neurological examination. As seen in our study, abnormal neurological findings like sensory deficits, reduced SLR, and muscle weakness can predict underlying disc pathology and nerve root compression. Such examinations, when combined with targeted MRI, can reduce unnecessary imaging and related costs, thereby alleviating the financial and psychological burden on patients. Moreover, given that some MRI findings may not correlate with symptoms, clinicians are urged to weigh clinical presentation heavily while interpreting imaging results, preventing overtreatment of incidental findings.

Limitations and Future Directions

Despite the meaningful correlations identified, our study has limitations. The cross-sectional design limits causal inferences between MRI findings and clinical symptoms. The sample size of 70 patients, though adequate for preliminary associations, may not capture the full variability in the population. Future studies should consider larger sample sizes and longitudinal designs to evaluate the progression of degenerative changes over time and their clinical implications. Further research is needed to explore the impact of conservative versus surgical treatment approaches based on specific MRI findings. Stratifying patients by severity of neural compression and correlating outcomes with interventions could provide more personalized treatment plans. Additionally, advances in imaging technology, such as high-resolution MRI and functional MRI, may offer deeper insights into the relationship between structural changes and pain generation, potentially identifying biomarkers for pain that extend beyond visible anatomical changes.

This study established a strong correlation between MRI findings and clinical presentations in patients with Lower back ache and radiculopathy. Disc bulges, protrusions, extrusions, and sequestrations, particularly those causing neural foraminal compromise and nerve root compression, were significantly associated with neurological deficits and specific dermatomal pain distributions. Although MRI is highly sensitive in detecting structural abnormalities, its findings should be interpreted alongside thorough neurological examinations to avoid overtreatment of incidental findings. The research underscores the importance of integrating imaging with clinical assessments to enhance diagnostic accuracy, inform treatment decisions, and improve patient outcomes. It also emphasizes the necessity for healthcare professionals to consider both radiological evidence and clinical symptoms for optimized management of radiculopathy.

Recommendations

Clinicians should integrate detailed MRI analysis with comprehensive neurological examinations for accurate radiculopathy diagnosis.

Prioritize treatment strategies targeting neural foraminal compromise to alleviate symptoms effectively.

Further research should focus on longitudinal studies to evaluate treatment outcomes based on MRI-clinical correlations.

Acknowledgment

I express heartfelt gratitude to my mentor, colleagues, and family for their unwavering support throughout this research. Special thanks to Dr. Inder Pawar for his expert guidance, and to all healthcare professionals and patients who participated, making this study possible. Their contributions, encouragement, and insights were invaluable. I am deeply thankful for the opportunity to pursue this meaningful work and for the continuous inspiration that fueled my journey to this achievement.

Funding: No funding sources.

Conflit of interest: The study was approved by the Institutional Ethics Committee.

Ethical Approval: Taken.

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