HERNIATED LUMBAR INTERVERTEBRAL DISCS: CORRELATION OF MAGNETIC RESONANCE IMAGING RESULTS WITH CLINICAL AND INTRAOPERATIVE DATA
Introduction: Magnetic resonance imaging (MRI) is undoubtedly the gold standard for diagnosing lumbar disc prolapse. Unfortunately, this is closely related to random finds. In this study, we sought to determine to what extent 1.5 Tesla MRI correlates with clinical features and intraoperative results in cases of lumbar disc prolapse. Methods: During a 2-year period, 50 consecutive patients with a herniated lumbar disc who required a discectomy were examined. The MRI results that we observed included the level of prolapse, type, position, migration, high-intensity zones, lateral depression and anterior wall stenosis. To determine the significance of various MRI results, a logistic regression analysis was performed. Finally, the results of MRI studies were confirmed by intraoperative data and conclusions were made. Study design: A single-center prospective study. Results: The sensitivity and specificity of MRI scans for determining surgically significant levels were 100% and 94.94%, respectively. The test for raising a straight leg (Lasega's symptom) was positive in 74% of patients, with 85%, 43% and 75% for paramedian, medial and foraminal localization, respectively. Foraminal compression was the only MRI parameter that had a significant association with neurological deficits. In patients with high-intensity zones, a significant increase in back pain was observed on MRI, and 63% had identifiable ring tears during surgery. The results of intraoperative anatomy were significantly correlated with the results of MRI. Conclusions: The results of MRI strongly correlate with intraoperative features and can serve as a useful tool in the planning of surgery due to the accurate description of morphometric features. However, the decision on surgery should be made only when detailed clinical data in combination with MRI results allow us to accurately identify the fragment of the disc that is the culprit and the pain generator.