Assessment of Appropriateness of MRI Study in Evaluation of Lumbar Spine in Adult Patients - A Retrospective Study

Abstract

Introduction: Degenerative disease of the lumbar spine is a common condition that radiologists encounter on a daily basis. The diagnostic imaging and clinical interventions for back pain are costly which adds considerable burden on health care systems. MRI plays an important role in the assessment of low back pain and lumbar spine.A radiologic report holds lesser value, if previous history and clinical evaluation are not suggestive of a pathology. Hence, the aim of the present study was to investigate the appropriateness of MRI usage of lumbar spine among adult patients. Material and Methods: This retrospective study in which all the cases of lumbar spine MR imaging during the defined period were included. The demographic details included the patient’s age, gender, chief complaints, followed by duration of symptoms and specialities of prescribing physician. All patients underwent lumbosacral spine MRI to be included in the study. The inclusion criterion was lumbar back pain experienced in standing position whereas the patients with any previous spine surgery at any level and/or referred inability to maintain standing position for the scheduled examination time were excluded from this study. Results: Lumbar disc bulging was the most common diagnosis, followed by scoliosis, kyphosis and infection. Chief complaints such as walk difficulties, back injury and referred leg pain were associated with greater chance of detecting potentially clinically positive lumbar MR image findings, as compared to simple back pain. Duration of back pain, leg pain, back and leg pain and walking difficulties were not found to be associated with greater rate of potentially clinically positive lumbar spine diagnosis. Conclusion: Magnetic resonance imaging has proven to be an indispensable tool for the orthopaedic spine surgery than x-rays. The value in assessing normal lumbar anatomy, internal disc chemistry and architecture, features of lumbar spine degeneration, and in diagnosing herniated lumbar discs has been well documented. Thus, MRI is the best non-invasive approach which provides a clear 3D visualization of spinal structures for the detection of lumbar pathologies.