one of the leading causes of musculoskeletal disability, affecting individuals across different age groups and contributing substantially to reduced productivity, healthcare expenditure, and impaired quality of life.[1] Among its various etiologies, lumbar intervertebral disc degeneration is an important structural abnormality associated with chronic pain, radiculopathy, and functional limitations. Lumbar disc degeneration is a progressive pathological process involving biochemical and structural alterations, including depletion of proteoglycans, reduced water content, disruption of annular fibres, and loss of disc height. Ageing, genetic predisposition, mechanical loading, and occupational factors contribute to its progression, potentially resulting in disc bulging, herniation, spinal canal narrowing, and neural compression.[2]Magnetic resonance imaging (MRI) is the preferred imaging modality for detailed assessment of lumbar disc pathology because of its superior soft-tissue resolution, multiplanar capabilities, and absence of ionizing radiation. It enables evaluation of disc hydration, morphology, height, vertebral endplates, and associated neural compression. The Pfirrmann grading system provides a standardized classification of lumbar disc degeneration based on MRI signal intensity, disc structure, differentiation between the nucleus pulposus and annulus fibrosus, and disc height, facilitating objective assessment of degenerative severity.[3]Despite its diagnostic utility, the relationship between MRI findings and clinical manifestations remains inconsistent. Jensen et al. demonstrated that disc bulges and protrusions frequently occur in asymptomatic individuals.[4] Similarly, Brinjikji et al. reported that degenerative spinal abnormalities become increasingly prevalent with advancing age, even among individuals without low back pain.[5] However, their subsequent meta-analysis demonstrated that certain degenerative MRI findings were more common in symptomatic individuals than asymptomatic controls.[6] These observations emphasize that radiological abnormalities should be interpreted alongside clinical symptoms rather than in isolation.Clinical manifestations of lumbar disc degeneration include localized low back pain, radiating lower limb pain, paresthesia, restricted spinal mobility, and difficulty performing daily activities. Suri et al. demonstrated associations between newly developed MRI abnormalities, particularly annular fissures, and subsequent low back pain or radicular symptoms.[7] However, the relationship between structural abnormalities and functional impairment is influenced by several clinical and individual factors. The Oswestry Disability Index (ODI) is a validated patient-reported outcome measure that assesses disability across ten domains of daily functioning and provides a quantitative assessment of functional limitations associated with low back pain.[8]Previous investigations evaluating the association between MRI-detected degeneration and clinical disability have yielded conflicting results. Udby et al. reported that disc degeneration and facet joint degeneration were not associated with long-term disability in patients with chronic low back pain.[9] Similarly, Kasch et al. observed that most degenerative MRI findings demonstrated limited clinically important associations with current or future low back pain.[10] In contrast, Han et al., in a systematic review, identified weak associations between certain MRI abnormalities and subsequent pain or disability outcomes.[11] More recently, Thapa et al. demonstrated that common MRI findings, including disc herniation and degeneration, did not independently correlate with ODI-based disability, although selected degenerative abnormalities were associated with functional impairment.[12]These inconsistencies highlight the need for further investigation into the clinical relevance of individual MRI characteristics and their relationship with patient-reported disability. Therefore, the present study was designed to evaluate lumbar intervertebral disc degeneration using MRI and determine its correlation with clinical symptoms and functional disability assessed by the Oswestry Disability Index.

This hospital-based, prospective, observational, cross-sectional study was conducted at a tertiary care hospital to evaluate lumbar intervertebral disc degeneration using magnetic resonance imaging (MRI) and determine its correlation with clinical symptoms and functional disability assessed by the Oswestry Disability Index (ODI).A total of 130 patients aged 18 years and above, presenting with low back pain with or without radicular symptoms and referred for MRI evaluation of the lumbosacral spine, were included in the study. Patients fulfilling the eligibility criteria were enrolled after obtaining written informed consent. Inclusion Criteria • Patients aged 18 years and above. • Patients presenting with low back pain, with or without radiculopathy. • Patients with suspected lumbar degenerative disc disease undergoing MRI. • Patients who provided written informed consent. Exclusion Criteria • Patients with previous lumbar spine surgery. • Patients with acute spinal trauma or vertebral fractures. • Patients with spinal infections, malignancies, or inflammatory spinal disorders. • Patients with congenital spinal deformities. • Patients with contraindications to MRI or inability to complete the ODI questionnaire. Data Collection and Clinical Assessment Demographic and clinical details, including age, sex, occupation, duration of symptoms, and relevant medical history, were recorded using a structured proforma. Clinical evaluation included assessment of low back pain, radiculopathy, numbness, paresthesia, muscle weakness, and restricted spinal movements. Neurological examination and straight leg raising tests were performed. Pain intensity was assessed using the Visual Analog Scale (VAS), ranging from 0 (no pain) to 10 (worst imaginable pain). MRI Examination and Evaluation MRI of the lumbosacral spine was performed using a standardized imaging protocol comprising sagittal T1-weighted, sagittal T2-weighted, and axial T2-weighted sequences. Intervertebral discs from L1–L2 to L5–S1 were systematically evaluated for disc desiccation, disc height reduction, disc bulge, protrusion, extrusion, annular fissures, spinal canal stenosis, neural foraminal narrowing, and nerve root compression. The severity of disc degeneration was assessed using the Pfirrmann grading system (Grades I–V) based on MRI signal intensity, disc structure, nucleus–annulus differentiation, and disc height. Classification and Grouping of Patients Based on MRI findings, patients were categorized into three groups according to the severity of lumbar disc degeneration: Group I (Mild degeneration): Pfirrmann Grades I–II. Group II (Moderate degeneration): Pfirrmann Grade III. Group III (Advanced degeneration): Pfirrmann Grades IV–V. In patients with multilevel disc involvement, the highest Pfirrmann grade was considered for patient-level classification. Clinical symptoms, VAS scores, and ODI scores were compared among the three groups. Assessment of Functional Disability Functional disability was assessed using the Oswestry Disability Index (ODI), which comprised ten domains evaluating pain intensity and limitations in daily activities. Each domain was scored from 0 to 5, and the total score was converted into a percentage. Patients were categorized as having minimal disability (0–20%), moderate disability (21–40%), severe disability (41–60%), crippled disability (61–80%), or bed-bound/symptom exaggeration category (81–100%). Higher scores indicated greater functional impairment. Outcome Measures Primary Outcome The primary outcome was the correlation between MRI-based Pfirrmann grades of lumbar disc degeneration and functional disability assessed using ODI scores. Secondary Outcomes Secondary outcomes included associations between MRI degeneration severity and VAS scores, duration of symptoms, radiculopathy, disc herniation, spinal canal stenosis, and neural compression. Statistical Analysis The collected data were entered into Microsoft Excel and analyzed using statistical software. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. One-way analysis of variance (ANOVA) or the Kruskal–Wallis test was applied to compare continuous variables among the three groups. The Chi-square test or Fisher's exact test was used for categorical variables. Spearman's rank correlation coefficient was calculated to determine associations between Pfirrmann grades, ODI scores, and VAS scores. A p-value <0.05 was considered statistically significant.

A total of 130 patients with lumbar disc degeneration were included in the study. The majority belonged to the 41–50 years age group (29.23%), with males constituting 55.38% of participants. Based on MRI degeneration severity, 23.08% had mild degeneration (Group I), 37.69% had moderate degeneration (Group II), and 39.23% had advanced degeneration (Group III) (Table 1)Low back pain was present in all patients (100%), followed by radicular pain (63.08%), restricted lumbar movements (58.46%), positive straight leg raising test (53.08%), numbness (46.92%), and paresthesia (41.54%). Muscle weakness was observed in 24.62% of patients (Table 2).MRI evaluation revealed disc desiccation as the most common finding (86.15%), followed by disc bulge (72.31%), reduced disc height (52.31%), neural foraminal narrowing (45.38%), and disc protrusion (43.85%). Nerve root compression and spinal canal stenosis were observed in 39.23% and 36.92% of patients, respectively (Table 3 and Figure 1).A statistically significant association was observed between MRI degeneration severity and functional disability (p<0.001). Minimal disability predominated in Group I (66.67%), moderate disability in Group II (57.14%), and severe disability in Group III (50.98%). Additionally, 29.41% of patients in Group III had crippled disability, indicating increasing functional impairment with advancing degeneration (Table 4 and Figure 2).Mean age and symptom duration increased significantly across the three groups (p<0.001). Radicular pain increased from 30.00% in Group I to 84.31% in Group III, while numbness increased from 16.67% to 68.63%. Mean VAS scores increased from 3.8 ± 1.1 to 7.3 ± 1.3, and mean ODI scores from 18.6 ± 7.4% to 57.4 ± 12.6%, with significant differences across groups (p<0.001) (Table 5).Spearman correlation analysis demonstrated significant positive correlations between Pfirrmann grade and age (ρ = 0.482), symptom duration (ρ = 0.526), VAS score (ρ = 0.684), and ODI score (ρ = 0.721), with all p-values <0.001. The strongest correlation was observed with ODI score, indicating greater functional disability with increasing MRI degeneration severity (Table 6 and Figure 3). Table 1. Distribution of Study Participants According to Demographic and Clinical Characteristics (N = 130) Characteristics Number (n) Percentage (%) Age group (years) 18–30 18 13.85 31–40 29 22.31 41–50 38 29.23 51–60 27 20.77 >60 18 13.85 Gender Male 72 55.38 Female 58 44.62 Duration of symptoms 12 months 53 40.77 MRI degeneration severity Group I – Mild (Grades I–II) 30 23.08 Group II – Moderate (Grade III) 49 37.69 Group III – Advanced (Grades IV–V) 51 39.23 Table 2. Distribution of Clinical Symptoms Among Study Participants (N = 130) Clinical symptoms Number (n) Percentage (%) Low back pain 130 100.00 Radicular pain 82 63.08 Numbness 61 46.92 Paresthesia 54 41.54 Restricted lumbar movements 76 58.46 Muscle weakness 32 24.62 Positive straight leg raising test 69 53.08 Table 3. Distribution of MRI Findings Among Study Participants (N = 130) MRI findings Number (n) Percentage (%) Disc desiccation 112 86.15 Disc bulge 94 72.31 Disc protrusion 57 43.85 Disc extrusion 19 14.62 Reduced disc height 68 52.31 Annular fissure 45 34.62 Spinal canal stenosis 48 36.92 Neural foraminal narrowing 59 45.38 Nerve root compression 51 39.23 Table 4. Distribution of Functional Disability According to MRI Degeneration Severity (N = 130) ODI disability category Group I Mild (n=30), n (%) Group II Moderate (n=49), n (%) Group III Advanced (n=51), n (%) Total (N=130), n (%) p-value Statistical test Minimal (0–20%) 20 (66.67) 5 (10.20) 1 (1.96) 26 (20.00) < 0.001 Chi-square test Moderate (21–40%) 9 (30.00) 28 (57.14) 8 (15.69) 45 (34.62) Severe (41–60%) 1 (3.33) 14 (28.57) 26 (50.98) 41 (31.54) Crippled (61–80%) 0 (0.00) 2 (4.08) 15 (29.41) 17 (13.08) 81–100% 0 (0.00) 0 (0.00) 1 (1.96) 1 (0.77) Total 30 (100.00) 49 (100.00) 51 (100.00) 130 (100.00) Table 5. Comparison of Clinical Symptoms, VAS Scores, and ODI Scores According to MRI Degeneration Severity (N = 130) Parameters Group I Mild (n=30) Group II Moderate (n=49) Group III Advanced (n=51) p-value Statistical test Age (years), mean ± SD 37.8 ± 10.2 46.5 ± 11.3 54.2 ± 10.8 <0.001 ANOVA Duration of symptoms (months), mean ± SD 5.8 ± 3.2 10.4 ± 5.1 17.6 ± 7.3 <0.001 ANOVA Radicular pain, n (%) 9 (30.00) 30 (61.22) 43 (84.31) <0.001 Chi-square Numbness, n (%) 5 (16.67) 21 (42.86) 35 (68.63) <0.001 Chi-square Paresthesia, n (%) 4 (13.33) 19 (38.78) 31 (60.78) <0.001 Chi-square Muscle weakness, n (%) 2 (6.67) 9 (18.37) 21 (41.18) 0.001 Chi-square Restricted lumbar movements, n (%) 9 (30.00) 27 (55.10) 40 (78.43) <0.001 Chi-square Positive straight leg raising test, n (%) 6 (20.00) 25 (51.02) 38 (74.51) <0.001 Chi-square VAS score, mean ± SD 3.8 ± 1.1 5.6 ± 1.2 7.3 ± 1.3 <0.001 ANOVA ODI score (%), mean ± SD 18.6 ± 7.4 36.8 ± 10.2 57.4 ± 12.6 <0.001 ANOVA Table 6. Correlation Between MRI Degeneration Severity, Clinical Parameters, and Functional Disability (N = 130) Clinical parameters Spearman correlation coefficient (ρ) p-value Statistical test Pfirrmann grade vs age 0.482 <0.001 Spearman correlation Pfirrmann grade vs duration of symptoms 0.526 <0.001 Pfirrmann grade vs VAS score 0.684 <0.001 Pfirrmann grade vs ODI score 0.721 <0.001

The present study evaluated the association between MRI-detected lumbar disc degeneration, clinical symptoms, pain severity, and functional disability among 130 patients. Increasing MRI degeneration severity was significantly associated with older age, longer symptom duration, greater neurological symptom burden, and higher VAS and ODI scores.In the present study, the majority of patients belonged to the 41–50 years age group (29.23%), with a male predominance (55.38%). Mild, moderate, and advanced degeneration were observed in 23.08%, 37.69%, and 39.23% of patients, respectively. Mean age increased significantly from 37.8 ± 10.2 years in mild degeneration to 54.2 ± 10.8 years in advanced degeneration (p<0.001). Teraguchi et al. [13], in the Wakayama Spine Study involving 975 participants, reported disc degeneration in 71% of males and 77% of females younger than 50 years, increasing to more than 90% among individuals older than 50 years. Similarly, Gebrewold and Tesfaye [14] reported a mean age of 43.81 years among 72 patients, with 59.7% being females. These findings supported the association of disc degeneration with advancing age, although gender distribution varied between studies. Low back pain was present in all patients (100%), followed by radicular pain (63.08%), restricted lumbar movements (58.46%), numbness (46.92%), and paresthesia (41.54%). Mean symptom duration increased from 5.8 ± 3.2 months in mild degeneration to 17.6 ± 7.3 months in advanced degeneration (p<0.001). Herman et al. [15] reported that chronic low back pain was commonly defined as pain persisting for at least three months, although symptom frequency and functional impact were also important. Their analysis showed that applying the NIH definition reduced the proportion classified as having chronic low back pain by 25%. Teraguchi et al. [13] also reported an association between lumbar disc degeneration and low back pain. These findings highlighted the importance of evaluating symptom duration and clinical manifestations alongside MRI abnormalitiesDisc desiccation was the most frequent MRI finding (86.15%), followed by disc bulge (72.31%), reduced disc height (52.31%), neural foraminal narrowing (45.38%), and disc protrusion (43.85%). Disc extrusion was observed in 14.62% of patients. Gebrewold and Tesfaye [14] similarly identified disc bulge as the most common MRI abnormality, affecting 81.9% of patients, compared with 72.31% in the present study. Fardon et al. [16] emphasized standardized differentiation between disc bulge, protrusion, and extrusion, noting that MRI morphology alone does not establish clinical significance. These observations supported the importance of accurate MRI interpretation combined with clinical evaluation.A significant association was observed between MRI degeneration severity and ODI disability categories (p<0.001). Minimal disability predominated in mild degeneration (66.67%), whereas moderate disability was most frequent in Group II (57.14%). Among patients with advanced degeneration, 50.98% had severe disability and 29.41% had crippled disability. Mean ODI scores increased from 18.6 ± 7.4% to 57.4 ± 12.6% across mild and advanced degeneration groups. In contrast, Gebrewold and Tesfaye [14] reported minimal disability in 45.8% and moderate disability in 34.7% of patients. They observed only a weak correlation between spinal canal stenosis severity and ODI score, with no significant correlation for foraminal stenosis. The stronger association in the present study may reflect differences in MRI grading methods, study populations, and disability severity.The prevalence of radicular pain increased from 30.00% in mild degeneration to 84.31% in advanced degeneration. Similarly, numbness increased from 16.67% to 68.63%, muscle weakness from 6.67% to 41.18%, and positive straight leg raising test findings from 20.00% to 74.51%. Mean VAS scores increased significantly from 3.8 ± 1.1 to 7.3 ± 1.3 (p<0.001). Teraguchi et al. [13] reported an association between lumbar disc degeneration and low back pain, supporting the clinical relevance of degenerative changes. However, Fardon et al. [16] emphasized that MRI abnormalities should not be considered independently diagnostic of symptomatic nerve compression. These findings reinforced the importance of correlating radiological severity with clinical examination and pain assessment.The present study demonstrated significant positive correlations between Pfirrmann grade and age (ρ = 0.482), symptom duration (ρ = 0.526), VAS score (ρ = 0.684), and ODI score (ρ = 0.721), with all p-values <0.001. The strongest correlation was observed with functional disability. Teraguchi et al. [13] similarly demonstrated an age-related increase in disc degeneration, whereas Gebrewold and Tesfaye [14] reported weaker associations between individual MRI abnormalities and ODI scores. Herman et al. [15] emphasized the importance of symptom duration and patient-reported health in evaluating chronic low back pain. Collectively, these findings suggested that MRI degeneration grading, when combined with clinical and functional assessment, may improve the evaluation of symptomatic lumbar degenerative disc disease.

The present study demonstrated a positive association between MRI-based lumbar disc degeneration severity, clinical symptoms, pain intensity, and functional disability. Higher Pfirrmann grades were associated with increased VAS and ODI scores, indicating greater pain and functional limitations. MRI findings should therefore be interpreted alongside clinical examination and disability assessment for comprehensive evaluation of lumbar degenerative disc disease. LIMITATIONS The single-centre, cross-sectional design and relatively small sample size limited the generalizability of the findings and prevented causal interpretation. The absence of an asymptomatic control group and adjustment for potential confounding factors may have influenced the observed associations.

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