Correlation Between Patterns of Clinical Presentation and Mri Findings in Adult Patients With Lumbosacral Sensory & Motor Radiculopathy Secondary to Degenerative Disc Disease in Kenyatta National & Coptic Hospitals

Abstract

Background: Low back Pain (LBP) is a common complaint in patients with degenerative disc disease (DDD) with a global prevalence of 1.4-20%. Between 12-40% of patients with LBP have radiculopathy. The biggest challenge in spine surgery is choosing the correct surgical procedure for alleviation of symptoms and signs that the patient has with minimal or absence of complications. This is achieved by correct clinical evaluation and relating findings to the MRI. While MRI is the gold standard of evaluation of lumbar DDD, there are inconsistencies that cloud decision making. These inconsistencies such as findings of MRI changes in disc anatomy for symptomatic and asymptomatic patients, whereby minimal changes have been observed in patients with severe radicular pain or patients presenting with less pain having advanced MRI changes. Therefore, there is a need to examine how the patterns of presentation correlate to common reported disc changes in MRI scans. Objective: To determine the correlation between clinical presentation and MRI findings in patients with lumbosacral radiculopathy secondary to degenerative disc disease (DDD) in Kenyatta National Hospital & Coptic Hospital. Study Design: A Cross-sectional study undertaken at Kenyatta National Hospital (KNH) and Coptic Hospital (CH). Patients and methods: Eighty nine adult patients of either sex who presented with low back pain associated with lumbosacral radiculopathy at the KNH and Coptic hospital during the study period were included. Clinical assessment of patients with LBP and lumbosacral radiculopathy was done at review in the hospital clinics. The presence and level of sensory radiculopathy including pain, paresthesia and numbness was recorded. Details of MRI findings was based on recently done scans in patients presenting with ready films or requested as per protocol of care by resident or specialist for subsequent review as part of routine patient care. The degree of lumbar disc degeneration based of Pfirrmann grade, degree of vertebral end plate changes based on modic grades as well as anatomic and locational disc herniation were the MRI parameters that were studied. 2 Data was collected via a preformatted questionnaire administered to patients, and later keyed into the Statistical Package of Social Sciences (SPSS) version 23.0 for analysis. Descriptive statistics was applied to patient characteristics that included the demographic profile, clinical presentation and findings. Correlation between severity of lower back pain and radiculopathy with MRI findings was done using Analysis of Variance (ANOVA) test. Significance and Relevance: In view of the high direct & indirect cost in management of patients with low back pain & radiculopathy, the findings of this study will hopefully be a guide of which pathological lesions in DDD are associated with certain symptoms, thus aid in decision making particularly on which patients that may require surgery versus those that could benefit from less invasive procedures like selective nerve root block, bearing in mind spine surgery can have debilitating repercussions thus reduce morbidity in patient care. This is in the background of limited local data correlating severity of sensory & motor radiculopathy with MRI findings. Results: Out of the 89 patients who participated in the study 66 (76.4%) of them were females while 21 (23.6%) were males. The mean age of the patients was 51.5 (SD 12.7) years, where the minimum age was 24.0 years and the maximum age was 80.0 years. Majority of the patients were employed were 41 (46.1%). All of the 89 participants recruited in our study had low back pain and radicular pain to the lower limb with 78.7% reporting radiation to the feet whereby the left limb had majority at 44.9%. Paresthesia was reported by 95.5% of participants, 74.2% reported numbness while motor radiculopathy was reported in 9%. Results of the disc pathology indicate that 64 (71.9%) of the patients had 1 level pathology (71.9%). The most involved disc was L5S1 with 56 (62.9%) of all the patients affected. Total number of levels were 119 in the 89 participants. The locational pattern was reported as either central, paracentral or far lateral, where Paracentral pattern was the highest at 75 (63.0%). Anatomical pattern of disc pathology was reported as bulge, protrusion, extrusion or sequestration, where the highest was bulge at 70 (58.8%). Results of mean pain score was observed to be increasing with severity of the disk degeneration, and an Analysis of Variance (ANOVA) test was used to determine the association between the severity of lower back pain and radiculopathy with anatomical disc pathology, and the results indicate there was a statistical significant relation (p=0.030). Results of mean pain score was observed to be increasing as the grade was increasing, and an Analysis of Variance (ANOVA) test was used to determine the association between the severity of lower back pain and radiculopathy 3 with the Pfirrmann grade, but the results indicated there was no statistical significant relation (p=0.249). Conclusion: Our study has shown correlation between clinical severity of radiculopathy and pattern of MRI findings consistent with degenerative disc disease. This underscores the utility of thorough clinical assessments and judicious utilization of MRI as there were some instances where clinical picture was not in tandem with MRI findings.