concordance between clinical examination and mri findings and its effect on surgical outcome in patients with lumbosacral radiculopathy

1. Abstract 1.1. Background: Lumbosacral radiculopathy is a common cause of pain and disability. Surgical intervention improves pain and quality of life in patients who do not respond to conservative treatment. A proportion of patients experience their symptoms in a different dermatomal distribution to what might be expected from abnormalities seen on MRI. Previous investigators have concluded that clinical examination and dermatomal maps are inaccurate in this group, and that anatomical variability exists. This study investigates clinical outcome following surgical treatment of this patient cohort. 1.2. Materials and Methods: Surgical outcome data from 137 spinal surgery patients at a teaching hospital over 6 years were analysed retrospectively. Patients were divided into two groups - those whose examination findings were concordant with their MRI findings, and those whose findings were non-concordant. Improvements in validated surgical outcome measures were compared between the two groups. 1.3. Results: The concordant group (n = 100) improved significantly (P < 0.05) across 9 out of 10 measures. The non-concordant group (n = 37) improved significantly across 8 out of 10 measures. The difference in improvement between the two groups was not significant. 1.4. Conclusion: The non-concordant group appeared to have surgical outcomes as good as the concordant group. This suggests that the pathology seen on MRI is the source of the patient’s symptoms, and is in keeping with previous research suggesting that dermatomal innervation is variable, and clinical examination using dermatome maps can be inaccurate. The study is limited by its size and its retrospective nature. A larger, prospective study could confirm these results. 2. Abbreviations: MRI       :               Magnetic Resonance Imaging CT          :               Computed Tomography ESP         :               Extended Scope Practitioner LBOS     :               Low-Back Outcome Score ODI        :               Oswestry Disability Index MSPQ    :               Modified Somatic Perception Questionnaire VAS        :               Visual Analogue Scale ADL       :               Activities of Daily Living SD           :               Standard Deviation MRC      :               Medical Research Council