MAGNETIC RESONANCE IMAGING PATTERNS OF LUMBAR DEGENERATIVE DISC DISEASE AND THEIR ASSOCIATION WITH CLINICAL SYMPTOMS AMONG ADULTS WITH LOW BACK PAIN IN PESHAWAR, PAKISTAN

Abstract

Background: Low back pain is a major cause of functional limitation and healthcare utilization among adults. Magnetic resonance imaging (MRI) is the preferred imaging modality for evaluating intervertebral discs, spinal canals, nerve roots, vertebral endplates, and other soft-tissue abnormalities. However, degenerative abnormalities detected on MRI do not always correspond with the severity or distribution of patients' symptoms. Locally generated evidence is needed to improve the clinical interpretation of lumbar spine MRI findings in patients from Peshawar.

Objective: To describe the MRI patterns of lumbar degenerative disc disease and determine their association with pain severity, neurological symptoms, and functional disability among adults presenting with low back pain in Peshawar, Pakistan.

Methods: A hospital-based cross-sectional study was conducted in the radiology departments of selected tertiary care hospitals and diagnostic centres in Peshawar. Adult patients aged 18 years and above referred for lumbar spine MRI because of persistent low back pain were recruited through consecutive sampling. MRI examinations were performed using standardized sagittal and axial T1- and T2-weighted sequences. Imaging findings included disc desiccation, disc-height reduction, annular fissure, disc bulge, protrusion, extrusion, spinal canal stenosis, neural foraminal narrowing, nerve-root compression, facet-joint arthropathy, and Modic endplate changes. Degenerative severity was graded using established radiological classification systems. Clinical information included pain duration, visual analogue scale (VAS) score, radiculopathy, sensory or motor deficits, and Oswestry Disability Index (ODI) score. Associations between MRI abnormalities and clinical outcomes were assessed using multivariable regression analysis.

Results: A total of 140 patients (71 females, 69 males; mean age 41.8 ± 13.3 years) with persistent low back pain were enrolled. MRI findings demonstrated a progressive increase in degenerative changes from the upper to the lower lumbar spine. The L4–L5 level exhibited the most frequent findings (72.1% diffuse bulge), followed by L5–S1 (35.7% diffuse bulge and 25.0% central herniation). Disc degeneration (Pfirrmann grade ≥3) was present in 48.6% of patients. Modic changes were observed in 40% of patients; Type I changes showed a statistically significant correlation with histopathological inflammation (P = 0.002). Disc herniation and spinal stenosis showed a significant positive correlation with ODI scores (P < 0.001 and P = 0.002, respectively). Higher body mass index (BMI) was significantly associated with disc pathology at upper lumbar levels (L1–L2: P = 0.0207; L2–L3: P = 0.0048).

Conclusion: Lumbar degenerative changes on MRI demonstrate a clear caudad progression, with L4–L5 and L5–S1 being the most frequently affected levels. While disc herniation and spinal stenosis correlate with functional disability, other common findings such as isolated disc degeneration may represent incidental age-related changes. These findings support a judicious approach to MRI interpretation, emphasizing correlation with clinical presentation rather than reliance on imaging findings alone.