Correlation of Clinical and MRI Findings With Intraoperative Findings in Lumbar Intervertebral Disc Prolapse: A...

Background and objectives Low back pain represents a substantial global health burden, affecting a significant proportion of individuals throughout their lifetime, with lumbar intervertebral disc prolapse constituting the predominant underlying pathology. Magnetic resonance imaging has emerged as the diagnostic gold standard for lumbar disc herniation assessment, though debate persists regarding the clinical significance and predictive value of specific imaging findings. This investigation aimed to comprehensively characterize clinical manifestations, magnetic resonance imaging morphometric features, and intraoperative anatomical findings in patients with lumbar intervertebral disc prolapse and to establish concordance relationships among these diagnostic modalities for optimizing surgical planning and evidence-based therapeutic decision-making. Methodology This prospective observational study enrolled 47 consecutive patients with lumbar intervertebral disc prolapse undergoing surgical discectomy at a tertiary teaching hospital between September 2022 and December 2023. Inclusion criteria mandated unsuccessful conservative management for a minimum of eight weeks. Clinical assessment documented radiculopathy patterns and neurological deficits. Standardized 1.5 Tesla magnetic resonance imaging evaluated herniation level, morphological type, anatomical location, fragment migration, high-intensity zones, and lateral recess and foraminal stenosis. Patients satisfying clinical and radiological criteria underwent surgical intervention. Intraoperative findings, including herniation morphology, fragment migration, annular integrity, lateral recess stenosis, and nerve root compression patterns, were systematically documented and correlated with preoperative assessments. Results The study cohort demonstrated a mean age of 43.66 years with a standard deviation of 9.38 years, comprising 37 males (78.7%) and 10 females (21.3%). Clinical presentation revealed left-sided radiculopathy in 25 (53.2%) patients, right-sided involvement in 15(31.9%) patients, and bilateral manifestations in 7 (14.9%) patients. Magnetic resonance imaging identified the fourth-fifth lumbar level as the predominant herniation site in 28 (59.6%) patients, with extrusion representing the principal morphological type in 23 (48.9%) patients. Central herniation location was documented in 18 (38.3%) patients, while high-intensity zones were present in 28 (59.6%) patients. Intraoperative findings revealed extrusion in 27 (57.4%) patients, annular tears in 33 (70.2%) patients, and bilateral foraminal stenosis in 23 (48.9%) patients. Left traversing fifth lumbar nerve root compression predominated in 19 (40.4%) patients. Overall tripartite concordance among clinical, radiological, and surgical findings was achieved in 41 (87.2%) patients, with perfect herniation level identification in all 47 (100%) patients. Conclusion Magnetic resonance imaging demonstrates excellent reliability for anatomical localization and neural compression prediction in lumbar intervertebral disc prolapse, establishing its essential role in preoperative surgical planning. However, significant bilateral foraminal stenosis underestimation and fragment migration discordance necessitate integration of comprehensive clinical assessment, advanced imaging interpretation, and intraoperative visualization to guide optimal therapeutic decision-making and decompression adequacy.