Categorization of Pathology Causing Low Back Pain using Magnetic Resonance Imaging (MRI)

Abstract

Background: Low backache is the most common ailment flooding the orthopaedic clinic. Most of the population at least once seek medical attention for low back ache. Magnetic Resonance Imaging (MRI) is a non invasive, commonly used diagnosing modality and accurate in diagnosing pathology causing low back ache.

Aim: To classify and quantify the causes of low back pain referred to radiology department by MRI.

Materials and methods: Patients with back pain referred to radiology department were subjected to single MRI scan after ruling out any contraindications using the following sequences: T1W Turbo Spin Echo, T2W Turbo Spin Echo, Gradient-echo, Myelogram and short TI inversion recovery (STIR), in all imaging planes. Gadolinium enhanced T1W turbo spin echo sequence was used wherever necessary.

Results: Data were analysed using Excel 2007, SPSS 14, Students t-test. Degenerative disc diseases were the commonest pathology followed by congenital and traumatic lesions. Neoplastic lesions were the least common. Commonest herniation type being the disc bulge (79%) followed by disc protrusion (15%), disc extrusion (6%) and disc sequestration (<1%). The posterolateral disc herniation as the commonest and foraminal the least. Sacralisation was the most common congenital spinal anomaly, followed by lumbar scoliosis and perineural cyst. There is no sex difference in disc protrusion but male preponderance in disc extrusion with subligmentous extrusion.

Conclusion: MRI is useful in classifying the spinal lesions which again influences the treatment modality and clinical outcome. Degenerative disc disease is the single most common category which accounts for most the Low Back Ache for which a preventing strategy should be drafted.

Keywords: Degenerative disc disease; Low backache; Magnetic resonance imaging.

[Table/Fig-7]:

Coronal T2W images showing heterogeneous increased signal involving the T12, L1 vertebral bodies and the intervening disc with vertebral body/endplate destruction and bilateral paraspinal extension which turned out to be a case of tuberculous spondylodiscitis

[Table/Fig-8]:

Sagittal T2W image showing slightly lobular intermediate signal intense extradural Schwannoma measuring about 2.4 cm in craniocaudal dimension located inantero left lateral epidural space at L5 vertebral level causing lateral recess obliteration and traversing nerve root compression

[Table/Fig-9]:

Sagittal T1 & T2W images of lumbosacral spine demonstratingawell defined T1 hypo and T2 hyper intense (CSF isointense) perineural cystic lesion (Tarlov Cyst)at S2-3 intervertebral level

[Table/Fig-10]:

Sagittal T1 & T2W images showingpathological collapse, loss of definition and destruction of the L4 vertebral body demonstrating diffuse low T1 and T2W signal intensity with posterior convex bulging of the vertebral body cortex indenting the thecal sac