Affiliations: [a] Department of Nuclear Medicine, Goethe University, Frankfurt/Main, Germany | [b] Institute for Diagnostic and Interventional Radiology, Goethe University, Frankfurt/Main, Germany | [c] Department of Spine Surgery, Asklepios Clinic Lindenlohe, Lindenlohe, Schwandorf, Germany
Correspondence:
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Corresponding author: Marcus Middendorp, Department of Nuclear Medicine, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. Tel.: +49 69 6301 4330; Fax: +49 69 6301 3858; E-mail:middendorp@info.mctunes.de
Note: [1] M.F. Khan and A. Maataoui contributed equally to this work.
Abstract: BACKGROUND: Low back pain and lumbar intervertebral disc
degeneration (IDD) are common findings. Valid data on correlation between
clinical pain scores and grades of IDD are not available. OBJECTIVE: To investigate the correlation of intervertebral disc
degeneration (IDD) at lumbar levels L4/5 and L5/S1 and the Oswestry
Disability Index (ODI). METHODS: The lumbar discs L4/5 and L5/S1 of 591 patients were
evaluated according to the 5-point (Grade I to Grade V) grading system as
published by Pfirrmann et al. Functional status was assessed using the
Oswestry Disability Index. Spearman's coefficient of rank correlation was
used for statistical analysis (p < 0.05). RESULTS: The majority of patients revealed lumbar discs with
Pfirrmann grade II to grade IV changes (93.3% at level L4/5; 89.8%
at level L5/S1), while a relatively low percentage of lumbar discs presented
with grade I (level L4/5: 1.5%; level L5/S1: 2.0%) or grade V (level
L4/5: 5.1%; level L5/S1: 8.1%) changes, respectively. Patients' ODI
scores ranged between 0 and 91.11% (arithmetic mean of 32.77% ±
17.02%). The largest group of patients (48.39%) had moderate
functional disability (ODI score between 21 and 40%). There was a weak,
but statistically significant positive correlation between IDD and ODI for
both evaluated lumbar levels. CONCLUSIONS: Increased lumbar IDD in MRI goes along with an
increased ODI. Thus, MRI is a strong indicator of a patient's clinical
appearance. However, low back pain cannot be explained by imaging alone.
Clinical correlation is imperative for an adequate diagnostic advance in
patients with low back pain.
Keywords: Lumbar spine, low back pain, intervertebral disc degeneration, magnetic resonance imaging, Oswestry Disability Index
