Magnetic resonance imaging findings in Ghanaian patients presenting with low back pain: A single centre study 

Magnetic resonance imaging findings in Ghanaian patients presenting with low back pain: A single centre study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Magnetic resonance imaging findings in Ghanaian patients presenting with low back pain: A single centre study Godwill Acquah, Derick Seyram Sule, Lawrence Fesi, Kofi Adesi Kyei, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5898112/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Apr, 2025 Read the published version in BMC Medical Imaging → Version 1 posted 4 You are reading this latest preprint version Abstract Background Due to the high prevalence of low back pain which impacts the lives of those affected, several studies have explored findings associated with the lumbar spine which is the affected anatomy using magnetic resonance imaging (MRI). This provides a better understanding of the pathology in the study setting and adds to the literature on the subject which is useful during intervention. However, there is a paucity of literature in the Ghanaian context. This study therefore explored the patterns of MRI findings in patients with low back pain. Method A one-year retrospective cross-sectional design with a purposive sampling method was used to retrieve data from 59 MRI lumbar spine radiologist reports with a clinical history of low back pain. Data was analysed using SPSS v26 and Jamovi 2.5.6. Statistical significance was deduced at p < 0.05. Results Radiological reports with a history of low back pain accounted for 32.6% of the total (n = 181) reports identified. A male-to-female ratio of 0.74:1 was identified with a mean age of 44.7 ± 16.1 years. Disc degeneration (93.2%, n = 55) and lumbar spondylolysis (76.3%, n = 45) were the two main findings identified as the most prevalent across reports. The lordotic curvatures of patients with low back pain were predominantly normal (74.6% n = 44). Disc degeneration was strongly associated with L4/L5 (V = 0.644). Conclusion The prevalent finding identified was disc degeneration frequently located at L4/L5. While this study could be a stepping stone for future research in this context, it provides some level of evidence which could be useful to Ghanaian healthcare providers for more focused assessments and interventions. This targeted approach can enhance diagnostic accuracy and improve treatment outcomes for patients suffering from low back pain, facilitating timely and appropriate management strategies. Clinical trial number Not applicable Low back pain MRI Lumbar spine disc degeneration Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Background Low back pain (LBP) is now the leading cause of disability globally, and the most prevalent among all musculoskeletal conditions. 1 It is a pervasive health concern, affecting individuals of all ages and demographics. 2 By far, about 60–80% of the population will experience LBP at some point in their lives 2 with a significant proportion reporting persistent or recurrent symptoms that impact daily functioning, work productivity, and overall quality of life. 3 The prevalence of LBP worldwide is estimated to be between 30 and 80% among the general population and has been found to increase with age. 4 An annual prevalence of 57% has also been reported among a section of the African populace. 5 In Ghana, the prevalence of LBP in a rural setting was reportedly 15.7%. 6 As a crucial part of the musculoskeletal system, the lumbar spine, which consists of the five vertebrae (L1–L5), intervertebral discs, facet joints, ligaments, and muscles, provides the spinal cord and nerve roots with structural support, flexibility, and protection. 7 However, the lumbar spine is susceptible to various diseases that can result in LBP due to the complex interactions between its anatomical elements. 8 In the clinical evaluation of patients with LBP, diagnostic imaging plays a significant part in defining the underlying cause and guiding appropriate management strategies. Among the imaging modalities available, magnetic resonance imaging (MRI) has emerged as the preferred modality for assessing the lumbar spine due to its unparalleled soft tissue contrast and multiplanar imaging capabilities. 9 MRI enables detailed visualisation of the spinal anatomy, including the vertebral bodies, intervertebral discs, spinal cord, nerve roots, and surrounding soft tissues, allowing for the detection of a wide range of abnormalities contributing to LBP. 10 MRI findings associated with LBP include but are not limited to degenerative changes, facet joint arthropathy, spinal stenosis, neurogenic claudication, spondylolisthesis, and infections. 11,12,13 Several abnormalities could be present in the lumbar spine of patients with LBP. This makes interpreting MRI findings of this pathology very difficult. As a result, radiologist reports which contain a detailed assessment provide an excellent opportunity to systematically analyse patterns of findings in patients. 14 In light of this, several studies have been conducted in different settings which offer a wealth of information that could aid interventions. 15,16,17,18,19,20 This is not the case in Ghana as there is a paucity of literature regarding this area. A study by Kyei et al. 21 , sought to identify the prevalence and causes of LBP based on radiological reports. However, the study lacked emphasis on MRI findings although it reported that MRI and post-myelogram computed tomography appeared to be more diagnostic than plain X-rays. Furthermore, a more recent study regarding this context had limited focus where the authors investigated how facet joint arthrosis relates to LBP. 22 Thus, the patterns of MRI findings among patients with LBP in Ghana are unclear. This retrospective study therefore sought to investigate patterns of MRI findings in patients with LBP in a single centre in Ghana. Specifically, the objectives were to identify prevalent pathological findings and how they relate to age and the lumbar spine anatomy. Methods Study design, study site, population and sample size A retrospective cross-sectional study design was used since it allows access to a large pool of readily available data. 23,24 The study site was the Radiology Department of the Korle Bu Teaching Hospital which is the largest hospital in Ghana and arguably West Africa. Conclusive MRI radiologist reports of patients who presented for MRI lumbar spine examinations with histories of LBP from January 2023 to December 2023 at the hospital formed the study population, totalling 59. This eventually became the study sample as all were included in the study. A sample of the report can be identified in the supplementary sheet. Sampling technique, inclusion and exclusion criteria A non-probability purposive sampling method was employed as it intentionally highlights participants for a study based on the quality of interest. 25 Since this study considered MRI lumbar spine radiologist reports with a history of LBP, this form of sampling was best suited. The study included all MRI lumbar spine radiologist reports of patients from January 2023 to December 2023 who underwent lumbar spine MRI examinations due to complaints of LBP. Radiologist reports with a history other than LBP and inconclusive reports were excluded. MRI protocol MRI protocol Patients underwent MRI examination in a supine position using a 1.5 Tesla Toshiba Vantage Titan MRI machine with serial number GH-0029-01-CMR-01 and a surface coil. The standard lumbar MRI procedure was applied, which included stacked or contiguous axial T2 weighted, axial T1weighted turbo spin-echo sequences, 4-mm sagittal T1 weighted, coronal T2 weighted, sagittal T2 weighted, and short tau inversion recovery. Data collection tool A structured data collection sheet (Supplementary sheet) designed in Microsoft Excel (version 16) to capture relevant information from radiologist reports, including demographic details, clinical details, and MRI findings was applied. The structured sheet allowed for efficient data collection, enabling the researchers who are experts in the field to quickly extract pertinent information from radiologist reports without the need for manual transcription or interpretation. Sections on the sheet included age, gender, main finding, lumbar vertebrae involved, other findings per vertebrae, disc space involved, other findings per the disc space involved, region of termination of the spinal cord, and lordotic curvature. The data collection sheet was pilot-tested to ensure its reliability and validity in capturing the necessary information accurately. 26 Data collection procedure Data was collected after ethical approval was granted and with permission from the management of the hospital’s Radiology Department. The hospital’s radiological data is stored on a picture archiving and communications system. Hence, with assistance from the information technology personnel and radiographers at the study site, the required data which were digital copies of conclusive radiologists’ reports on all MRI lumbar spine scans were retrieved using a personal 32-gigabyte flash drive. The retrieved data was sorted to include only reports that meet the inclusion criteria. After, the relevant variables were extracted and inserted into the self-designed Microsoft Excel spreadsheet. Data analysis Data analysis was conducted with the statistical package for social sciences (SPSS) version 26 (IBM Corp., Armonk, NY, USA) and Jamovi 2.5.6. Both descriptive and inferential statistics were employed in this study. To harness the analysis, the extracted main and other abnormal findings were re-coded as either positive or negative depicting their presence or absence across reports. Descriptive statistics was used to describe the data set using bar graphs and tables to present frequencies of various variables. The chi-square goodness of fit ( X 2 ) test was used to ascertain associations between variables. Where the assumptions of the chi-square test (i.e. cell count assumption) were violated Fisher’s exact test was utilised. Phi coefficient and Cramer’s V were used to assess the strength of significant associations. A coefficient above 0.25 was deemed a strong association. 27 Statistical significance was deduced at p < 0.05. Ethical consideration This study was approved by the ethics committee of the University of Ghana, School of Biomedical and Allied Health Sciences (SBAHS/AA/RAD/ 10918774/2023–2024 ). To ensure the confidentiality and anonymity of the patients whose reports were included, identification numbers were used instead of the patient’s name, also all patients’ and radiologists’ names on reports were blacked out by using the highlighter tool in Microsoft Word 2016 and setting the colour to black. Results Distribution of radiological reports and demographic data From Table 1 , it was identified that the majority (57.6%, n = 34) of the reports belonged to females. The most predominant age group identified was 30–39 years (25.4%, n = 15) although the overall mean age and standard deviation was 44.7 ± 16.1 years. The most prevalent region in the lumbar anatomy where the spinal cord terminated was reported to be the first lumbar vertebrae (L1) (54.2%, n = 32). The lordotic curvatures reported were predominantly normal (74.6%, n = 44). Table 1 Summary of the demographic data identified Variable Category Frequency (n) Percentage (%) Total n (%) Radiological reports LBP 59 32.6 181 (100%) Non-LBP 122 64.1 Gender Females 34 57.6 59 (100.0%) Male 25 42.4 Age group 10–19 2 3.4 59 (100.0%) 20–21 7 11.9 30–39 15 25.4 40–49 13 22.0 50–59 10 16.9 60–69 8 13.6 70–79 3 5.1 80–89 1 1.7 Spinal cord termination T12 3 5.1 58 (98.3%) T12/L1 3 5.1 L1 32 54.2 L1/L2 7 11.9 L2 11 18.6 L2/L3 2 3.4 Lordotic curvature Normal 44 74.6 57 (96.6%) Kyphotic deformity 1 1.7 Loss of Lordotic curve 3 5.1 Straightening 9 15.3 NB Only 58 and 57 of the reports included spinal cord termination and lordotic curvature respectively. LBP = low back pain. Distribution of main pathological findings As shown in Table 2 , the two main findings identified across reports were disc degeneration and lumbar spondylosis. The most prevalent among the two was disc degeneration (93.2%, n = 55) followed by lumbar spondylosis (76.3%, n = 45). Further, these two major findings co-existed for the majority of the time per reports such that all reports having lumbar spondylosis also had disc degeneration (76.3%, n = 45). This association using Fisher’s exact test and Cramer’s V was significant and strong (p = 0.038, V = 0.325). Table 2 Summary of the distribution of main pathological findings Main finding Frequency (n) Percentage (%) Total n (%) Finding Category Disc degeneration Positive 55 93.2 59 (100.0%) Negative 4 6.8 Lumbar spondylosis Positive 45 76.3 59 (100.0%) Negative 14 23.7 Disc degeneration * Lumbar spondylosis crosstabulation Lumbar spondylosis Total n (%) p-value V Negative Positive Disc degeneration Negative (n) % 3 (5.1%) 1 (1.7%) 4 (6.8%) 0.038 0.325 Positive (n) % 11 (18.6%) 44 (74.6%) 55 (93.2%) Total 14 (23.7%) 45 (76.3%) 59 (100.0%) Positive = present on report Negative = absent on report V = Cramer’s V p-value = Fisher’s exact Distribution of intervertebral discs with disc degeneration It was identified (Fig. 1 ) that the lumbar disc space most affected by disc degeneration across reports in descending order was L4/L5 (89.8%, n = 54), L5/S1 (86.4%, n = 52), L3/L4 (76.3%, n = 45), L2/L3 (71.2%, n = 42) and L1/L2 (69.5%, n = 41). This associated trend was significant such that the intervertebral disc region with the strongest association (Cramer’s V) in descending order followed the same trend. Distribution of pathologies arising from disc degeneration per intervertebral disc Overall, 8 pathologies were identified (Fig. 2 ) which included inter-disc height reduction, facet joint arthrosis, enlarged ligamentum flava, anterior theca indentation, spinal canal stenosis, neural foramina narrowing, nerve root compression, and cauda equina stenosis. Among these, facet joint arthrosis was the most prevalent, given its high prevalence in all the intervertebral disc spaces (L1/L2 = 64.4%, L2/L3 = 54.2%, L3/L4 = 49.2%, L4/L5 = 52.5% and L5/S1 = 64.4%) across reports. Further, facet joint arthrosis was significantly associated with L1/L2 to L5/S1. Accordingly, the intervertebral disc space with the strongest association was L1/L2 (V = 0.891) with L4/L5 having the least strong association (V = 0.320). On the contrary, neural foramina narrowing was significantly associated with all but L1/L2 intervertebral disc space with L3/L4 having the strongest association (V = 0.567). Distribution of findings regarding vertebral bodies The vertebral body across reports with the highest frequency of abnormality (Fig. 3 ) in descending order were L5 (61%, n = 36), L4 (59.3%, n = 35), L3 (55.9%, n = 33), L2 (44.1%, n = 26) and L1 (37.3%, n = 22). Lumbar spondylosis was significantly associated with all the lumbar vertebrae except L1 (Fig. 4 ) with the strongest associations noted at L5 (Phi = 0.453) and L4 (Phi = 0.430). Four abnormal findings (Fig. 5 ) were identified relating to the vertebral bodies which included osteophytes, Schmorl’s node, vertebral height reduction and intraosseous lipoma. Osteophytes were the most prevalent abnormality identified per their frequency on the five lumbar vertebras, with L3 (52.5%, n = 31) and L4 (52.5%, n = 31) being the regions with the most frequency. This was followed by Schmorl’s node, with L5 (10.1% n = 6), vertebral height reduction, occurring most often in the L4 region (13.6%, n = 8) and intraosseous lipoma. Association between main findings and age A trend was observed where the frequency of disc degeneration rose across the age groups, peaked at 30–39 years, and began to dwindle. This association was insignificant (p = 0.055). However, disc degeneration had higher frequencies between ages 30 and 70 years. Also, lumbar spondylosis had higher frequencies as age increased such that between ages 30 and 70 years, lumbar spondylosis was more prevalent. Below age 30 lumbar spondylosis was rare. This association was significant (p = 0.004). These are summarised in Fig. 6 . Sample MRI radiological images and findings Figure 8 . Sagittal STIR (A), T1 (B) and T2 (C), and Axial T2 (L3/L4, L4/L5 and L5/S1 Levels) (D-F) MRI images of the lumbosacral region of a 69-year-old female depicting spondylosis with multilevel degenerative disc disease involving the L3/L4, L4/L5 and L5/S1 intervertebral discs. These are worst at the L4/L5 and L5/S1 Levels where there is spinal canal stenoses, neural foramina narrowing with nerve root compressions. Discussion Most LBP cases were females with a male-to-female ratio of 0.74:1 relatable in the context of LBP. 28 The possible reasons could be hormonal factors, anatomical differences, and psychosocial factors among others. 29 Hormonal fluctuations, particularly in postmenopausal women, are known to affect bone density and spinal health, potentially contributing to higher LBP prevalence among females. 29 Additionally, females may be more likely to report pain or seek medical care, further skewing the observed ratio. 30 However, these factors do not fully explain the above disparity. 31,32 It was also revealed that the age group with the most LBP was between 30 and 70 years comparable to other studies and reports. 1,33 Regarding the lordotic curvatures, the majority of the reports revealed a normal curvature. In the literature, the relationship between lumbar lordosis and LBP is indeed complex and remains a subject of ongoing debate. Although some studies indicate that a reduced lumbar lordotic angle may be associated with LBP, particularly in cases involving disc herniation or degeneration 34 , the evidence is far from conclusive. Other research 35 , found no significant correlation between lumbar lordotic angle and the occurrence of LBP. This inconsistency could be attributed to various factors, including age, gender, body mass index, and ethnicity, which are known to influence lumbar lordosis. 36 Hence, further research is imperative in this area. Two main abnormalities identified in this study were disc degeneration and lumbar spondylosis of which the most prevalent was disc degeneration (Table 2 ). The finding regarding the prevalence of disc degeneration is comparable to a similar study conducted in Nepal which found disc degeneration was the most prevalent finding. 15 However, the findings contradict a study conducted in Nigeria which reported disc prolapse as the most prevalent finding. 37 A possible explanation is the difference in the study setting and inclusion criteria of the studies. In Iyidobi et al. 37 , the study setting was an orthopaedic hospital and MRI reports were from patients who needed surgical intervention. Interestingly all reports where spondylosis was identified also had disc degeneration showing a significant association between the two pathologies (Table 2 ). This suggests that regarding patients with LBP, disc degeneration may be a precursor or contributing factor to the development of spondylosis and vice versa. According to Middleton and Fish 38 , degeneration of the intervertebral discs often results in structural changes in the spine, such as osteophyte formation and disc space narrowing, which are characteristic of spondylosis. This study revealed that the commonest intervertebral disc space where disc degeneration frequently occurred was L4/L5 followed by L5/S1 (Fig. 1 ) indicating that the lower intervertebral segments especially L4/L5 is the most affected by disc degeneration in this study regarding LBP. Again, the fact that this same region in this study had a strong association with the abnormality (Fig. 1 ) speaks volumes about its vulnerability to degenerative changes. These findings are consistent with similar studies. 20,37,39 According to Liyew 40 , more than 80% of lumbar disc degeneration occurs at L4/L5 and L5/S1. Regarding this, Ghanaian clinicians should pay special attention to the L4/L5 and L5/S1 regions when diagnosing and managing lumbar spine disorders in patients with LBP. Further, the eight abnormalities identified as causative by disc degeneration (Fig. 2 ) showcase how various abnormalities arise from disc degeneration regarding LBP. In particular, facet joint arthrosis was the most prevalent finding which is unsurprising as its occurrence is strongly associated with disc degeneration 41 similarly identified in this study. The other three most prevalent findings were neural foramina narrowing, anterior theca indentation, and spinal canal stenosis. Among the four abnormalities identified in the lumbar vertebrae, osteophytes were the most common, particularly affecting L3 and L4 the most (Fig. 5 ). However, since lumbar spondylosis is associated with osteophytes, 38 was prevalent (Table 2 ) and has a strong association with the vertebrae bodies, this finding is expected. Following this, Schmorl’s nodes were frequently found, especially in the L5 region. The detection of Schmorl’s nodes aligns with research that suggests Schmorl’s nodes play a role in LBP. In a Turkish study 42 , Schmorl’s nodes were found in nearly one-third of patients with LBP and also correlated with severe disc degeneration and Modic changes in the upper and lower lumbar vertebrae. The detection of Schmorl’s nodes in this study potentially suggests the need for Ghanaian clinicians to consider them as potential contributors to LBP, especially in the lower lumbar spine, where mechanical loading is highest. Vertebral height reduction, another notable abnormality, was predominantly observed at L4. The least common abnormality identified was intraosseous lipoma which is consistent with the literature in terms of its rareness as a bone-related pathology mostly identified by incident. 43 The study revealed an intriguing trend in the occurrence of disc degeneration across age groups. The frequency of disc degeneration rose with age, peaking between 30 and 39 years, and then gradually declined (Fig. 6 ). Although this pattern was statistically insignificant, it provides valuable insights into the progression of degenerative spinal changes. By far, disc degeneration is globally known to increase with age and not to decline. A possible explanation could be the overwhelmingly high prevalence of disc degeneration in the sample (Table 2 ), which reduced the variability necessary to detect statistically significant age-related differences. Therefore, while the data suggest a pattern of disc degeneration peaking between ages 30 and 39, the lack of significance is likely due to insufficient variation within the sample. Despite this, the peak prevalence in the 30–39 age group may reflect a period of increased mechanical stress, as this age range coincides with peak professional activity and physical demands. Individuals in this group are likely still active in the workforce, contributing to the accumulation of stress on the spine, which may accelerate degenerative changes leading to LBP. Furthermore, this age group (30–39 years) also coincided with the emergence of lumbar spondylosis, an age-related spinal condition that was significantly associated with age in the study (Fig. 6 ) such that it was more prevalent between ages 30 and 70, and was rare below age 30. Factors such as posture, repetitive motions, and lifestyle habits may further exacerbate these degenerative changes. The higher frequencies of both disc degeneration and lumbar spondylosis observed between 30 and 70 years indicate that these conditions are prevalent in a substantial portion of the adult population. 44 This highlights the importance of early screening and intervention, particularly during the peak working years, to manage and mitigate the progression of spinal degeneration which leads to LBP. Limitations and recommendation Considering the small sample size of this study and the fact that it was a single-centre study, caution should be taken when making generalisations. This small sample size is attributed to frequent breakdowns of the MRI machine at the centre. Therefore, future studies should consider using multi-centers and collecting data in longer-duration intervals to get a greater pool of reports that could be generalisable. Conclusion The prevalent finding identified was disc degeneration frequently located at L4/L5. Additionally, the age group most affected is between 30 and 70, reinforcing the need for preventive measures during these active years. While this study could be a stepping stone for future research in this context, it provides some level of evidence which could be useful to Ghanaian healthcare providers for more focused assessments and interventions. This targeted approach can enhance diagnostic accuracy and improve treatment outcomes for patients suffering from low back pain, facilitating timely and appropriate management strategies. Abbreviations LBP Low back pain MRI Magnetic resonance imaging L1 First lumbar vertebrae L2 Second lumbar vertebrae L3 Third lumbar vertebrae L4 Fourth lumbar vertebrae L5 Fifth lumbar vertebrae L1/L2 First and second lumbar disc space L2/L3 Second and third lumbar disc space L3/L4 Third and fourth lumbar disc space L4/L5 Fourth and fifth lumbar disc space L5/S1 Fifth lumbar and first sacral disc space Declarations Ethical approval Following the Helsinki protocol, this study was approved by the ethics committee of the University of Ghana, School of Biomedical and Allied Health Sciences (SBAHS/AA/RAD/10918774/2023-2024). Consent for publication Consent for publishing radiological data was sought from the participants Availability of data and materials The data sets used and analysed during the current study are available from the corresponding author upon reasonable request. Competing interest The authors have no competing interest to declare Funding This research did not receive any specific funding. Author’s contributions GA contributed to the conceptualisation, design, data acquisition, analysis, interpretation of data, final draft and revision. DSA contributed to the conceptualisation, design, data acquisition, analysis, interpretation of data, final draft and revision. LF contributed to the conceptualisation, design, data acquisition, analysis, interpretation of data, final draft and revision. KAK contributed to the analysis, interpretation of data, final draft and revision. JLA contributed to the analysis, interpretation of data, final draft and revision. 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Quantitative imaging in medicine and surgery. 2016 Apr;6(2):199. https://doi.org/10.21037%2Fqims.2016.04.06 Thompson AE, Anisimowicz Y, Miedema B, Hogg W, Wodchis WP, Aubrey-Bassler K. The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study. BMC family practice. 2016 Dec;17:1–7. https://doi.org/10.1186%2Fs12875-016-0440-0 Schneider S. Why Do Women Have Back Pain More Than Men? A Representative Prevalence Study in the Federal Republic of Germany. J Clin Pain. 2006;22(7):738–747. https://doi.org/10.1097/01.ajp.0000210920.03289.93. Wong CK, Mak RY, Kwok TS, Tsang JS, Leung MY, Funabashi M, Macedo LG, Dennett L, Wong AY. Prevalence, incidence, and factors associated with non-specific chronic low back pain in community-dwelling older adults aged 60 years and older: a systematic review and meta-analysis. The journal of pain. 2022 Apr 1;23(4):509 − 34. https://doi.org/10.1016/j.jpain.2021.07.012 Mattiuzzi C, Lippi G, Bovo C. Current epidemiology of low back pain. J Hosp Manag Health Policy. 2020;4:15. https://doi.org/10.21037/jhmhp-20-17. Chun SW, Lim CY, Kim K, Hwang J, Chung SG. The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. Spine J. 2017;17(8):1180-91. https://doi.org/10.1016/j.spinee.2017.04.034. Shayesteh Azar M, Talebpour Amiri F, Alaee A, Hadinejad A, Sajadi M, Nozari A. Association of low back pain with lumbar lordosis and lumbosacral angle. J Mazandaran Univ Med Sci. 2010;20(75):47–53. https://doi.org/10.22088/jbums.20.75.47. Been E, Kalichman L. Lumbar lordosis. Spine J. 2014;14(1):87–97. https://doi.org/10.1016/j.spinee.2013.07.463. Iyidobi EC, Obande BO, Ekwunife RT. Pattern of MRI findings in patients with low back pain at National Orthopaedic Hospital, Enugu Nigeria. J Biosci Med. 2018;6(4):85–94. https://doi.org/10.4236/jbm.2018.64009. Middleton K, Fish DE. Lumbar spondylosis: clinical presentation and treatment approaches. Curr Rev Musculoskelet Med. 2009;2(2):94–104. https://doi.org/10.1007/s12178-009-9051-x. Thapa NB, Bajracharya S. Magnetic resonance imaging findings in patients with low backache. J Soc Surgeons Nepal. 2015;18:11 − 5. https://doi.org/10.3126/jssn.v18i2.18568 Liyew WA. Clinical presentations of lumbar disc degeneration and lumbosacral nerve lesions. International journal of rheumatology. 2020;2020(1):2919625. https://doi.org/10.1155/2020/2919625. Saleem S, Aslam HM, Rehmani MAK, Raees A, Alvi AA, Ashraf J. Lumbar disc degenerative disease: disc degeneration symptoms and magnetic resonance image findings. Asian Spine J. 2013;7(4):322. https://doi.org/10.4184/asj.2013.7.4.322. Ekşi MŞ, Turgut VU, Berikol G, Özmen BB, Huet SE, Dinç T, Küçüksüleymanoğlu D, Orhun Ö, Özcan-Ekşi EE. Schmorl’s nodes could be associated with intervertebral disc degeneration at upper lumbar levels and end-plate disease at lower lumbar level in patients with low back pain. Journal of Clinical Neuroscience. 2022 Jun 1;100:66–74. https://doi.org/10.1016/j.jocn.2022.04.004. Kang HS, Kim T, Oh S, Park S, Chung SH. Intraosseous lipoma: 18 years of experience at a single institution. Clinics in orthopedic surgery. 2018 Jun;10(2):234-9. https://doi.org/10.4055/cios.2018.10.2.234. Ozevren H, Cetin A, Baloglu M. Analysis of lumbar disc degeneration: 82 cases. Ann Med Res. 2019;26(12):2784-7. https://doi.org/10.5455/annalsmedres.2019.04.225 Additional Declarations No competing interests reported. Supplementary Files LSSupplementarysheet.docx Cite Share Download PDF Status: Published Journal Publication published 25 Apr, 2025 Read the published version in BMC Medical Imaging → Version 1 posted Editorial decision: Revision requested 04 Feb, 2025 Editor assigned by journal 29 Jan, 2025 Submission checks completed at journal 29 Jan, 2025 First submitted to journal 24 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5898112","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":408558739,"identity":"38023eff-858d-401f-bdef-e29a75663ac8","order_by":0,"name":"Godwill Acquah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYBCDBH4wxQbEEsRqkWwgWYvBAWK1yLs3P/zwts0uz/hG+gWGD2WHGeSjG/BrMTxzzFhybltysdmNnALGGecOMxjeOUBAy4wEM2beNubEbTdyEoCMwyARQlrSvwFV1idungHU8pcYLfISOSBbDidukEg/wMwI1CIvQUCLAc+ZYsk5544nzjjzhuFgz7l0HgNCWuTb2zd+eFNWndjfnv7wwY8yazl5Qg4DRwcPmMkDYUMiCJ8tDXAt7A8QIqNgFIyCUTAKkAAAJ3pH89OE608AAAAASUVORK5CYII=","orcid":"","institution":"University of Ghana","correspondingAuthor":true,"prefix":"","firstName":"Godwill","middleName":"","lastName":"Acquah","suffix":""},{"id":408558740,"identity":"3874cf57-4ce2-41e5-b498-54c0f6f93539","order_by":1,"name":"Derick Seyram Sule","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Derick","middleName":"Seyram","lastName":"Sule","suffix":""},{"id":408558742,"identity":"36ed4edd-8110-469c-abd0-7860ed98549e","order_by":2,"name":"Lawrence Fesi","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Lawrence","middleName":"","lastName":"Fesi","suffix":""},{"id":408558743,"identity":"ec5748ee-2c95-4eda-b731-81c3110401e0","order_by":3,"name":"Kofi Adesi Kyei","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Kofi","middleName":"Adesi","lastName":"Kyei","suffix":""},{"id":408558744,"identity":"4f745ea8-fae7-4f83-b128-a4e59d4c1d92","order_by":4,"name":"Jacob Leonard Ago","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Jacob","middleName":"Leonard","lastName":"Ago","suffix":""},{"id":408558745,"identity":"fe1672ec-e8d9-4974-951d-6151aceca746","order_by":5,"name":"Dennison Agala","email":"","orcid":"","institution":"=Cape Coast Teaching hospital","correspondingAuthor":false,"prefix":"","firstName":"Dennison","middleName":"","lastName":"Agala","suffix":""},{"id":408558746,"identity":"084b94e1-43f1-4629-9e98-f529a384a172","order_by":6,"name":"William K. Antwi","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"William","middleName":"K.","lastName":"Antwi","suffix":""}],"badges":[],"createdAt":"2025-01-24 20:23:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5898112/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5898112/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12880-025-01680-7","type":"published","date":"2025-04-25T15:57:38+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":75409922,"identity":"1f6bbbf6-8a82-466b-93e3-408158575d90","added_by":"auto","created_at":"2025-02-04 09:05:49","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":212240,"visible":true,"origin":"","legend":"\u003cp\u003eA bar graph of the distribution of intervertebral disc with disc degeneration. \u003cem\u003eNB: the frequencies for each represent the total number identified across reports. P-values were from Fisher’s exact.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5898112/v1/22bb440090c4b1ff1e5e7fe4.jpg"},{"id":75408134,"identity":"0f9b09eb-0951-4b97-bfd6-6b7da5a5246b","added_by":"auto","created_at":"2025-02-04 08:57:49","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":458536,"visible":true,"origin":"","legend":"\u003cp\u003eA bar graph of the distribution of pathologies arising from disc degeneration per inter-disc. \u003cem\u003eNB: the frequencies for each represent the total number identified across reports. The p-values were from Fisher’s exact.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5898112/v1/c07aaa57984603318e7323ff.jpg"},{"id":75408190,"identity":"82511be9-71b5-4af4-9179-cea2a83240f3","added_by":"auto","created_at":"2025-02-04 08:57:52","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":167433,"visible":true,"origin":"","legend":"\u003cp\u003eA bar graph of the distribution of vertebral bodies with pathologies. \u003cem\u003eNB: the frequencies for each represent the total number identified across reports.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5898112/v1/d5b48c0fa57baedbac6f5d5c.jpg"},{"id":75408164,"identity":"baf5dd24-360b-4c06-a50d-be6a72ed344d","added_by":"auto","created_at":"2025-02-04 08:57:51","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":205816,"visible":true,"origin":"","legend":"\u003cp\u003eA bar graph of the association between lumbar vertebrae and spondylosis. \u003cem\u003eNB: the frequencies for each represent the total number identified across reports. X\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e=chi-square test.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Picture4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5898112/v1/2e441cc76d6b442907578856.jpg"},{"id":75409944,"identity":"ed3e89b0-0666-444d-a4d9-da63805f107d","added_by":"auto","created_at":"2025-02-04 09:05:51","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":174155,"visible":true,"origin":"","legend":"\u003cp\u003eA bar graph of the distribution of pathologies associated with vertebral bodies per vertebral bodies. \u003cem\u003eNB: the frequencies for each represent the total number identified across reports.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Picture5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5898112/v1/a4bb14f7fefdd0d6c0c588b7.jpg"},{"id":75408143,"identity":"43d07ecb-cfe8-4aae-820f-2ba86a9567e9","added_by":"auto","created_at":"2025-02-04 08:57:50","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":300104,"visible":true,"origin":"","legend":"\u003cp\u003eA bar graph of the association between main findings and age. \u003cem\u003eNB: The p-value was from Fisher’s exact test.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Picture6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5898112/v1/cf933eb42684da6583e9ea20.jpg"},{"id":75409939,"identity":"3e5719d0-31be-41b7-8539-0b37b4f33667","added_by":"auto","created_at":"2025-02-04 09:05:51","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":145073,"visible":true,"origin":"","legend":"\u003cp\u003eSagittal STIR (A), T1 (B) and T2 (C) and Axial T2 (L4/L5 level) (D) MRI images of the lumbosacral region of a 33-year-old male depicting diffuse bulging of the L4/L5 degenerative disc causing severe spinal canal stenosis and compression of the L5 transverse nerves.\u003c/p\u003e","description":"","filename":"Picture7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5898112/v1/83528cf4be1c5d992cefc5cb.jpg"},{"id":75409968,"identity":"315703d9-3334-48fc-8112-5868a9e20265","added_by":"auto","created_at":"2025-02-04 09:05:53","extension":"jpg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":146189,"visible":true,"origin":"","legend":"\u003cp\u003eSagittal STIR (A), T1 (B) and T2 (C), and Axial T2 (L3/L4, L4/L5 and L5/S1 Levels) (D-F) MRI images of the lumbosacral region of a 69-year-old female depicting spondylosis with multilevel degenerative disc disease involving the L3/L4, L4/L5 and L5/S1 intervertebral discs. These are worst at the L4/L5 and L5/S1 Levels where there is spinal canal stenoses, neural foramina narrowing with nerve root compressions.\u003c/p\u003e","description":"","filename":"Picture8.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5898112/v1/de3ce685c059a1cce984bbc3.jpg"},{"id":81569627,"identity":"52a55a7b-c9ed-45ec-a9df-2567b660ff06","added_by":"auto","created_at":"2025-04-28 16:08:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2856035,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5898112/v1/0736239e-7413-4663-b9fb-051eccb11c87.pdf"},{"id":75408132,"identity":"4511454c-b96f-4c1e-97e5-76401cc3f5b9","added_by":"auto","created_at":"2025-02-04 08:57:49","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":164933,"visible":true,"origin":"","legend":"","description":"","filename":"LSSupplementarysheet.docx","url":"https://assets-eu.researchsquare.com/files/rs-5898112/v1/ad3eebcff50413bca912b1f1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Magnetic resonance imaging findings in Ghanaian patients presenting with low back pain: A single centre study ","fulltext":[{"header":"Background","content":"\u003cp\u003eLow back pain (LBP) is now the leading cause of disability globally, and the most prevalent among all musculoskeletal conditions.\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e It is a pervasive health concern, affecting individuals of all ages and demographics.\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e By far, about 60\u0026ndash;80% of the population will experience LBP at some point in their lives \u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e with a significant proportion reporting persistent or recurrent symptoms that impact daily functioning, work productivity, and overall quality of life.\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e The prevalence of LBP worldwide is estimated to be between 30 and 80% among the general population and has been found to increase with age.\u003csup\u003e\u003cb\u003e4\u003c/b\u003e\u003c/sup\u003e An annual prevalence of 57% has also been reported among a section of the African populace.\u003csup\u003e\u003cb\u003e5\u003c/b\u003e\u003c/sup\u003e In Ghana, the prevalence of LBP in a rural setting was reportedly 15.7%.\u003csup\u003e\u003cb\u003e6\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAs a crucial part of the musculoskeletal system, the lumbar spine, which consists of the five vertebrae (L1\u0026ndash;L5), intervertebral discs, facet joints, ligaments, and muscles, provides the spinal cord and nerve roots with structural support, flexibility, and protection.\u003csup\u003e\u003cb\u003e7\u003c/b\u003e\u003c/sup\u003e However, the lumbar spine is susceptible to various diseases that can result in LBP due to the complex interactions between its anatomical elements.\u003csup\u003e\u003cb\u003e8\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the clinical evaluation of patients with LBP, diagnostic imaging plays a significant part in defining the underlying cause and guiding appropriate management strategies. Among the imaging modalities available, magnetic resonance imaging (MRI) has emerged as the preferred modality for assessing the lumbar spine due to its unparalleled soft tissue contrast and multiplanar imaging capabilities.\u003csup\u003e\u003cb\u003e9\u003c/b\u003e\u003c/sup\u003e MRI enables detailed visualisation of the spinal anatomy, including the vertebral bodies, intervertebral discs, spinal cord, nerve roots, and surrounding soft tissues, allowing for the detection of a wide range of abnormalities contributing to LBP.\u003csup\u003e\u003cb\u003e10\u003c/b\u003e\u003c/sup\u003e MRI findings associated with LBP include but are not limited to degenerative changes, facet joint arthropathy, spinal stenosis, neurogenic claudication, spondylolisthesis, and infections.\u003csup\u003e\u003cb\u003e11,12,13\u003c/b\u003e\u003c/sup\u003e Several abnormalities could be present in the lumbar spine of patients with LBP. This makes interpreting MRI findings of this pathology very difficult. As a result, radiologist reports which contain a detailed assessment provide an excellent opportunity to systematically analyse patterns of findings in patients.\u003csup\u003e\u003cb\u003e14\u003c/b\u003e\u003c/sup\u003e In light of this, several studies have been conducted in different settings which offer a wealth of information that could aid interventions.\u003csup\u003e\u003cb\u003e15,16,17,18,19,20\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis is not the case in Ghana as there is a paucity of literature regarding this area. A study by Kyei et al.\u003csup\u003e\u003cb\u003e21\u003c/b\u003e\u003c/sup\u003e, sought to identify the prevalence and causes of LBP based on radiological reports. However, the study lacked emphasis on MRI findings although it reported that MRI and post-myelogram computed tomography appeared to be more diagnostic than plain X-rays. Furthermore, a more recent study regarding this context had limited focus where the authors investigated how facet joint arthrosis relates to LBP.\u003csup\u003e\u003cb\u003e22\u003c/b\u003e\u003c/sup\u003e Thus, the patterns of MRI findings among patients with LBP in Ghana are unclear. This retrospective study therefore sought to investigate patterns of MRI findings in patients with LBP in a single centre in Ghana. Specifically, the objectives were to identify prevalent pathological findings and how they relate to age and the lumbar spine anatomy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, study site, population and sample size\u003c/h2\u003e \u003cp\u003eA retrospective cross-sectional study design was used since it allows access to a large pool of readily available data.\u003csup\u003e\u003cb\u003e23,24\u003c/b\u003e\u003c/sup\u003e The study site was the Radiology Department of the Korle Bu Teaching Hospital which is the largest hospital in Ghana and arguably West Africa. Conclusive MRI radiologist reports of patients who presented for MRI lumbar spine examinations with histories of LBP from January 2023 to December 2023 at the hospital formed the study population, totalling 59. This eventually became the study sample as all were included in the study. A sample of the report can be identified in the supplementary sheet.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSampling technique, inclusion and exclusion criteria\u003c/h3\u003e\n\u003cp\u003eA non-probability purposive sampling method was employed as it intentionally highlights participants for a study based on the quality of interest.\u003csup\u003e\u003cb\u003e25\u003c/b\u003e\u003c/sup\u003e Since this study considered MRI lumbar spine radiologist reports with a history of LBP, this form of sampling was best suited. The study included all MRI lumbar spine radiologist reports of patients from January 2023 to December 2023 who underwent lumbar spine MRI examinations due to complaints of LBP. Radiologist reports with a history other than LBP and inconclusive reports were excluded.\u003c/p\u003e\n\u003ch3\u003eMRI protocol\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eMRI protocol\u003c/div\u003e \u003cp\u003ePatients underwent MRI examination in a supine position using a 1.5 Tesla Toshiba Vantage Titan MRI machine with serial number GH-0029-01-CMR-01 and a surface coil. The standard lumbar MRI procedure was applied, which included stacked or contiguous axial T2 weighted, axial T1weighted turbo spin-echo sequences, 4-mm sagittal T1 weighted, coronal T2 weighted, sagittal T2 weighted, and short tau inversion recovery.\u003c/p\u003e\n\u003ch3\u003eData collection tool\u003c/h3\u003e\n\u003cp\u003eA structured data collection sheet (Supplementary sheet) designed in Microsoft Excel (version 16) to capture relevant information from radiologist reports, including demographic details, clinical details, and MRI findings was applied. The structured sheet allowed for efficient data collection, enabling the researchers who are experts in the field to quickly extract pertinent information from radiologist reports without the need for manual transcription or interpretation. Sections on the sheet included age, gender, main finding, lumbar vertebrae involved, other findings per vertebrae, disc space involved, other findings per the disc space involved, region of termination of the spinal cord, and lordotic curvature. The data collection sheet was pilot-tested to ensure its reliability and validity in capturing the necessary information accurately.\u003csup\u003e\u003cb\u003e26\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eData collection procedure\u003c/h3\u003e\n\u003cp\u003e Data was collected after ethical approval was granted and with permission from the management of the hospital\u0026rsquo;s Radiology Department. The hospital\u0026rsquo;s radiological data is stored on a picture archiving and communications system. Hence, with assistance from the information technology personnel and radiographers at the study site, the required data which were digital copies of conclusive radiologists\u0026rsquo; reports on all MRI lumbar spine scans were retrieved using a personal 32-gigabyte flash drive. The retrieved data was sorted to include only reports that meet the inclusion criteria. After, the relevant variables were extracted and inserted into the self-designed Microsoft Excel spreadsheet.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData analysis was conducted with the statistical package for social sciences (SPSS) version 26 (IBM Corp., Armonk, NY, USA) and Jamovi 2.5.6. Both descriptive and inferential statistics were employed in this study. To harness the analysis, the extracted main and other abnormal findings were re-coded as either positive or negative depicting their presence or absence across reports. Descriptive statistics was used to describe the data set using bar graphs and tables to present frequencies of various variables. The chi-square goodness of fit (\u003cem\u003eX\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e) test was used to ascertain associations between variables. Where the assumptions of the chi-square test (i.e. cell count assumption) were violated Fisher\u0026rsquo;s exact test was utilised. Phi coefficient and Cramer\u0026rsquo;s V were used to assess the strength of significant associations. A coefficient above 0.25 was deemed a strong association.\u003csup\u003e\u003cb\u003e27\u003c/b\u003e\u003c/sup\u003e Statistical significance was deduced at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical consideration\u003c/h3\u003e\n\u003cp\u003eThis study was approved by the ethics committee of the University of Ghana, School of Biomedical and Allied Health Sciences (SBAHS/AA/RAD/\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10918774/2023\u0026ndash;2024\u003c/span\u003e\u003cspan address=\"10918774/2023\u0026ndash;2024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). To ensure the confidentiality and anonymity of the patients whose reports were included, identification numbers were used instead of the patient\u0026rsquo;s name, also all patients\u0026rsquo; and radiologists\u0026rsquo; names on reports were blacked out by using the highlighter tool in Microsoft Word 2016 and setting the colour to black.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eDistribution of radiological reports and demographic data\u003c/h2\u003e\n \u003cp\u003eFrom Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, it was identified that the majority (57.6%, n\u0026thinsp;=\u0026thinsp;34) of the reports belonged to females. The most predominant age group identified was 30\u0026ndash;39 years (25.4%, n\u0026thinsp;=\u0026thinsp;15) although the overall mean age and standard deviation was 44.7\u0026thinsp;\u0026plusmn;\u0026thinsp;16.1 years. The most prevalent region in the lumbar anatomy where the spinal cord terminated was reported to be the first lumbar vertebrae (L1) (54.2%, n\u0026thinsp;=\u0026thinsp;32). The lordotic curvatures reported were predominantly normal (74.6%, n\u0026thinsp;=\u0026thinsp;44).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of the demographic data identified\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency (n)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eRadiological reports\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e181 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-LBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e59 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"8\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u0026ndash;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"8\"\u003e\n \u003cp\u003e59 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u0026ndash;21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u0026ndash;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u0026ndash;69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70\u0026ndash;79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80\u0026ndash;89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003eSpinal cord termination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003e58 (98.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT12/L1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eL1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eL1/L2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eL2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eL2/L3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eLordotic curvature\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e74.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e57 (96.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKyphotic deformity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLoss of Lordotic curve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStraightening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eNB\u0026nbsp;\u003c/strong\u003e\u003cem\u003eOnly 58 and 57 of the reports included spinal cord termination and lordotic curvature respectively.\u003c/em\u003e \u003cstrong\u003eLBP\u003c/strong\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;low back pain.\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eDistribution of main pathological findings\u003c/h2\u003e\n \u003cp\u003eAs shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, the two main findings identified across reports were disc degeneration and lumbar spondylosis. The most prevalent among the two was disc degeneration (93.2%, n\u0026thinsp;=\u0026thinsp;55) followed by lumbar spondylosis (76.3%, n\u0026thinsp;=\u0026thinsp;45). Further, these two major findings co-existed for the majority of the time per reports such that all reports having lumbar spondylosis also had disc degeneration (76.3%, n\u0026thinsp;=\u0026thinsp;45). This association using Fisher\u0026rsquo;s exact test and Cramer\u0026rsquo;s V was significant and strong (p\u0026thinsp;=\u0026thinsp;0.038, V\u0026thinsp;=\u0026thinsp;0.325).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of the distribution of main pathological findings\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eMain finding\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFrequency (n)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003eTotal n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFinding\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eDisc degeneration\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e93.2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e59 (100.0%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eLumbar spondylosis\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e76.3\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\" rowspan=\"2\"\u003e\n \u003cp\u003e59 (100.0%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e23.7\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eDisc degeneration * Lumbar spondylosis crosstabulation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eLumbar spondylosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTotal n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eV\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eDisc degeneration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative (n) %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.325\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive (n) %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (18.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (74.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (93.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (23.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 (76.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003ePositive\u003c/strong\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;present on report\u003c/em\u003e \u003cstrong\u003eNegative\u003c/strong\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;absent on report\u003c/em\u003e \u003cstrong\u003eV\u003c/strong\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;Cramer\u0026rsquo;s V\u003c/em\u003e \u003cstrong\u003ep-value\u003c/strong\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;Fisher\u0026rsquo;s exact\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eDistribution of intervertebral discs with disc degeneration\u003c/h2\u003e\n \u003cp\u003eIt was identified (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e) that the lumbar disc space most affected by disc degeneration across reports in descending order was L4/L5 (89.8%, n\u0026thinsp;=\u0026thinsp;54), L5/S1 (86.4%, n\u0026thinsp;=\u0026thinsp;52), L3/L4 (76.3%, n\u0026thinsp;=\u0026thinsp;45), L2/L3 (71.2%, n\u0026thinsp;=\u0026thinsp;42) and L1/L2 (69.5%, n\u0026thinsp;=\u0026thinsp;41). This associated trend was significant such that the intervertebral disc region with the strongest association (Cramer\u0026rsquo;s V) in descending order followed the same trend.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eDistribution of pathologies arising from disc degeneration per intervertebral disc\u003c/h2\u003e\n \u003cp\u003eOverall, 8 pathologies were identified (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e) which included inter-disc height reduction, facet joint arthrosis, enlarged ligamentum flava, anterior theca indentation, spinal canal stenosis, neural foramina narrowing, nerve root compression, and cauda equina stenosis. Among these, facet joint arthrosis was the most prevalent, given its high prevalence in all the intervertebral disc spaces (L1/L2\u0026thinsp;=\u0026thinsp;64.4%, L2/L3\u0026thinsp;=\u0026thinsp;54.2%, L3/L4\u0026thinsp;=\u0026thinsp;49.2%, L4/L5\u0026thinsp;=\u0026thinsp;52.5% and L5/S1\u0026thinsp;=\u0026thinsp;64.4%) across reports. Further, facet joint arthrosis was significantly associated with L1/L2 to L5/S1. Accordingly, the intervertebral disc space with the strongest association was L1/L2 (V\u0026thinsp;=\u0026thinsp;0.891) with L4/L5 having the least strong association (V\u0026thinsp;=\u0026thinsp;0.320). On the contrary, neural foramina narrowing was significantly associated with all but L1/L2 intervertebral disc space with L3/L4 having the strongest association (V\u0026thinsp;=\u0026thinsp;0.567).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eDistribution of findings regarding vertebral bodies\u003c/h2\u003e\n \u003cp\u003eThe vertebral body across reports with the highest frequency of abnormality (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e) in descending order were L5 (61%, n\u0026thinsp;=\u0026thinsp;36), L4 (59.3%, n\u0026thinsp;=\u0026thinsp;35), L3 (55.9%, n\u0026thinsp;=\u0026thinsp;33), L2 (44.1%, n\u0026thinsp;=\u0026thinsp;26) and L1 (37.3%, n\u0026thinsp;=\u0026thinsp;22). Lumbar spondylosis was significantly associated with all the lumbar vertebrae except L1 (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e) with the strongest associations noted at L5 (Phi\u0026thinsp;=\u0026thinsp;0.453) and L4 (Phi\u0026thinsp;=\u0026thinsp;0.430). Four abnormal findings (Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e) were identified relating to the vertebral bodies which included osteophytes, Schmorl\u0026rsquo;s node, vertebral height reduction and intraosseous lipoma. Osteophytes were the most prevalent abnormality identified per their frequency on the five lumbar vertebras, with L3 (52.5%, n\u0026thinsp;=\u0026thinsp;31) and L4 (52.5%, n\u0026thinsp;=\u0026thinsp;31) being the regions with the most frequency. This was followed by Schmorl\u0026rsquo;s node, with L5 (10.1% n\u0026thinsp;=\u0026thinsp;6), vertebral height reduction, occurring most often in the L4 region (13.6%, n\u0026thinsp;=\u0026thinsp;8) and intraosseous lipoma.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eAssociation between main findings and age\u003c/h2\u003e\n \u003cp\u003eA trend was observed where the frequency of disc degeneration rose across the age groups, peaked at 30\u0026ndash;39 years, and began to dwindle. This association was insignificant (p\u0026thinsp;=\u0026thinsp;0.055). However, disc degeneration had higher frequencies between ages 30 and 70 years. Also, lumbar spondylosis had higher frequencies as age increased such that between ages 30 and 70 years, lumbar spondylosis was more prevalent. Below age 30 lumbar spondylosis was rare. This association was significant (p\u0026thinsp;=\u0026thinsp;0.004). These are summarised in Fig. \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003eSample MRI radiological images and findings\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eFigure 8\u003c/strong\u003e. Sagittal STIR (A), T1 (B) and T2 (C), and Axial T2 (L3/L4, L4/L5 and L5/S1 Levels) (D-F) MRI images of the lumbosacral region of a 69-year-old female depicting spondylosis with multilevel degenerative disc disease involving the L3/L4, L4/L5 and L5/S1 intervertebral discs. These are worst at the L4/L5 and L5/S1 Levels where there is spinal canal stenoses, neural foramina narrowing with nerve root compressions.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eMost LBP cases were females with a male-to-female ratio of 0.74:1 relatable in the context of LBP.\u003csup\u003e\u003cb\u003e28\u003c/b\u003e\u003c/sup\u003e The possible reasons could be hormonal factors, anatomical differences, and psychosocial factors among others.\u003csup\u003e\u003cb\u003e29\u003c/b\u003e\u003c/sup\u003e Hormonal fluctuations, particularly in postmenopausal women, are known to affect bone density and spinal health, potentially contributing to higher LBP prevalence among females.\u003csup\u003e\u003cb\u003e29\u003c/b\u003e\u003c/sup\u003e Additionally, females may be more likely to report pain or seek medical care, further skewing the observed ratio.\u003csup\u003e\u003cb\u003e30\u003c/b\u003e\u003c/sup\u003e However, these factors do not fully explain the above disparity.\u003csup\u003e\u003cb\u003e31,32\u003c/b\u003e\u003c/sup\u003e It was also revealed that the age group with the most LBP was between 30 and 70 years comparable to other studies and reports.\u003csup\u003e\u003cb\u003e1,33\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eRegarding the lordotic curvatures, the majority of the reports revealed a normal curvature. In the literature, the relationship between lumbar lordosis and LBP is indeed complex and remains a subject of ongoing debate. Although some studies indicate that a reduced lumbar lordotic angle may be associated with LBP, particularly in cases involving disc herniation or degeneration\u003csup\u003e\u003cb\u003e34\u003c/b\u003e\u003c/sup\u003e, the evidence is far from conclusive. Other research\u003csup\u003e\u003cb\u003e35\u003c/b\u003e\u003c/sup\u003e, found no significant correlation between lumbar lordotic angle and the occurrence of LBP. This inconsistency could be attributed to various factors, including age, gender, body mass index, and ethnicity, which are known to influence lumbar lordosis.\u003csup\u003e\u003cb\u003e36\u003c/b\u003e\u003c/sup\u003e Hence, further research is imperative in this area.\u003c/p\u003e \u003cp\u003eTwo main abnormalities identified in this study were disc degeneration and lumbar spondylosis of which the most prevalent was disc degeneration (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The finding regarding the prevalence of disc degeneration is comparable to a similar study conducted in Nepal which found disc degeneration was the most prevalent finding.\u003csup\u003e\u003cb\u003e15\u003c/b\u003e\u003c/sup\u003e However, the findings contradict a study conducted in Nigeria which reported disc prolapse as the most prevalent finding.\u003csup\u003e\u003cb\u003e37\u003c/b\u003e\u003c/sup\u003e A possible explanation is the difference in the study setting and inclusion criteria of the studies. In Iyidobi et al.\u003csup\u003e\u003cb\u003e37\u003c/b\u003e\u003c/sup\u003e, the study setting was an orthopaedic hospital and MRI reports were from patients who needed surgical intervention. Interestingly all reports where spondylosis was identified also had disc degeneration showing a significant association between the two pathologies (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This suggests that regarding patients with LBP, disc degeneration may be a precursor or contributing factor to the development of spondylosis and vice versa. According to Middleton and Fish\u003csup\u003e\u003cb\u003e38\u003c/b\u003e\u003c/sup\u003e, degeneration of the intervertebral discs often results in structural changes in the spine, such as osteophyte formation and disc space narrowing, which are characteristic of spondylosis.\u003c/p\u003e \u003cp\u003eThis study revealed that the commonest intervertebral disc space where disc degeneration frequently occurred was L4/L5 followed by L5/S1 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) indicating that the lower intervertebral segments especially L4/L5 is the most affected by disc degeneration in this study regarding LBP. Again, the fact that this same region in this study had a strong association with the abnormality (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) speaks volumes about its vulnerability to degenerative changes. These findings are consistent with similar studies.\u003csup\u003e\u003cb\u003e20,37,39\u003c/b\u003e\u003c/sup\u003e According to Liyew\u003csup\u003e\u003cb\u003e40\u003c/b\u003e\u003c/sup\u003e, more than 80% of lumbar disc degeneration occurs at L4/L5 and L5/S1. Regarding this, Ghanaian clinicians should pay special attention to the L4/L5 and L5/S1 regions when diagnosing and managing lumbar spine disorders in patients with LBP. Further, the eight abnormalities identified as causative by disc degeneration (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) showcase how various abnormalities arise from disc degeneration regarding LBP. In particular, facet joint arthrosis was the most prevalent finding which is unsurprising as its occurrence is strongly associated with disc degeneration\u003csup\u003e\u003cb\u003e41\u003c/b\u003e\u003c/sup\u003e similarly identified in this study. The other three most prevalent findings were neural foramina narrowing, anterior theca indentation, and spinal canal stenosis.\u003c/p\u003e \u003cp\u003eAmong the four abnormalities identified in the lumbar vertebrae, osteophytes were the most common, particularly affecting L3 and L4 the most (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). However, since lumbar spondylosis is associated with osteophytes,\u003csup\u003e\u003cb\u003e38\u003c/b\u003e\u003c/sup\u003e was prevalent (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) and has a strong association with the vertebrae bodies, this finding is expected. Following this, Schmorl\u0026rsquo;s nodes were frequently found, especially in the L5 region. The detection of Schmorl\u0026rsquo;s nodes aligns with research that suggests Schmorl\u0026rsquo;s nodes play a role in LBP. In a Turkish study \u003csup\u003e\u003cb\u003e42\u003c/b\u003e\u003c/sup\u003e, Schmorl\u0026rsquo;s nodes were found in nearly one-third of patients with LBP and also correlated with severe disc degeneration and Modic changes in the upper and lower lumbar vertebrae. The detection of Schmorl\u0026rsquo;s nodes in this study potentially suggests the need for Ghanaian clinicians to consider them as potential contributors to LBP, especially in the lower lumbar spine, where mechanical loading is highest. Vertebral height reduction, another notable abnormality, was predominantly observed at L4. The least common abnormality identified was intraosseous lipoma which is consistent with the literature in terms of its rareness as a bone-related pathology mostly identified by incident.\u003csup\u003e\u003cb\u003e43\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe study revealed an intriguing trend in the occurrence of disc degeneration across age groups. The frequency of disc degeneration rose with age, peaking between 30 and 39 years, and then gradually declined (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). Although this pattern was statistically insignificant, it provides valuable insights into the progression of degenerative spinal changes. By far, disc degeneration is globally known to increase with age and not to decline. A possible explanation could be the overwhelmingly high prevalence of disc degeneration in the sample (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), which reduced the variability necessary to detect statistically significant age-related differences. Therefore, while the data suggest a pattern of disc degeneration peaking between ages 30 and 39, the lack of significance is likely due to insufficient variation within the sample. Despite this, the peak prevalence in the 30\u0026ndash;39 age group may reflect a period of increased mechanical stress, as this age range coincides with peak professional activity and physical demands. Individuals in this group are likely still active in the workforce, contributing to the accumulation of stress on the spine, which may accelerate degenerative changes leading to LBP.\u003c/p\u003e \u003cp\u003eFurthermore, this age group (30\u0026ndash;39 years) also coincided with the emergence of lumbar spondylosis, an age-related spinal condition that was significantly associated with age in the study (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e) such that it was more prevalent between ages 30 and 70, and was rare below age 30. Factors such as posture, repetitive motions, and lifestyle habits may further exacerbate these degenerative changes. The higher frequencies of both disc degeneration and lumbar spondylosis observed between 30 and 70 years indicate that these conditions are prevalent in a substantial portion of the adult population.\u003csup\u003e\u003cb\u003e44\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis highlights the importance of early screening and intervention, particularly during the peak working years, to manage and mitigate the progression of spinal degeneration which leads to LBP.\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and recommendation\u003c/h2\u003e \u003cp\u003eConsidering the small sample size of this study and the fact that it was a single-centre study, caution should be taken when making generalisations. This small sample size is attributed to frequent breakdowns of the MRI machine at the centre. Therefore, future studies should consider using multi-centers and collecting data in longer-duration intervals to get a greater pool of reports that could be generalisable.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe prevalent finding identified was disc degeneration frequently located at L4/L5. Additionally, the age group most affected is between 30 and 70, reinforcing the need for preventive measures during these active years. While this study could be a stepping stone for future research in this context, it provides some level of evidence which could be useful to Ghanaian healthcare providers for more focused assessments and interventions. This targeted approach can enhance diagnostic accuracy and improve treatment outcomes for patients suffering from low back pain, facilitating timely and appropriate management strategies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eLBP \u0026nbsp; \u0026nbsp;\u0026nbsp;Low back pain\u003c/p\u003e\n\u003cp\u003eMRI \u0026nbsp; \u0026nbsp;\u0026nbsp;Magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003eL1 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;First lumbar vertebrae\u003c/p\u003e\n\u003cp\u003eL2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Second lumbar vertebrae\u003c/p\u003e\n\u003cp\u003eL3 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Third lumbar vertebrae\u003c/p\u003e\n\u003cp\u003eL4 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Fourth lumbar vertebrae\u003c/p\u003e\n\u003cp\u003eL5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Fifth lumbar vertebrae\u003c/p\u003e\n\u003cp\u003eL1/L2 \u0026nbsp;First and second lumbar disc space\u003c/p\u003e\n\u003cp\u003eL2/L3 \u0026nbsp;Second and third lumbar disc space\u003c/p\u003e\n\u003cp\u003eL3/L4 \u0026nbsp;Third and fourth lumbar disc space\u003c/p\u003e\n\u003cp\u003eL4/L5 \u0026nbsp;Fourth and fifth lumbar disc space\u003c/p\u003e\n\u003cp\u003eL5/S1 \u0026nbsp;Fifth lumbar and first sacral disc space\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing the Helsinki protocol, this study was approved by the ethics committee of the University of Ghana, School of Biomedical and Allied Health Sciences (SBAHS/AA/RAD/10918774/2023-2024).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent for publishing radiological data was sought from the participants\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets used and analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interest to declare\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor’s contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGA contributed to the conceptualisation, design, data acquisition, analysis, interpretation of data, final draft and revision. DSA contributed to the conceptualisation, design, data acquisition, analysis, interpretation of data, final draft and revision. LF contributed to the conceptualisation, design, data acquisition, analysis, interpretation of data, final draft and revision. KAK contributed to the analysis, interpretation of data, final draft and revision. JLA contributed to the analysis, interpretation of data, final draft and revision. DA contributed to the data acquisition, analysis, interpretation of data, final draft and revision. WKA contributed to the final draft and revision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the management of the radiology department at the Korle Bu Teaching Hospital for allowing access to radiologist reports.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Low Back Pain [Internet]. World Health Organization. 2023 [cited 2024 Jan 15]. 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Journal of Neurosciences in Rural Practice. 2023 Oct;14(4):681. https://doi.org/10.25259/JNRP_94_2023\u003c/li\u003e\n\u003cli\u003eJunod V, Elger B. Retrospective research: what are the ethical and legal requirements?. Swiss medical weekly. 2010 Feb 27;140(0708):1\u0026thinsp;\u0026minus;\u0026thinsp;0. https://doi.org/10.4414/smw.2010.13041\u003c/li\u003e\n\u003cli\u003eRamirez-Santana M. Limitations and Biases in Cohort Studies. In: Barr\u0026iacute;a RM, editor. Cohort Studies in Health Sciences. InTech; 2018. p. 29\u0026ndash;53. https://doi.org/10.5772/intechopen.74324\u003c/li\u003e\n\u003cli\u003eEtikan I, Musa SA, Alkassim RS. Comparison of Convenience Sampling and Purposive Sampling. American Journal of Theoretical and Applied Statistics. 2016;5(1):1\u0026ndash;4. https://doi.org/10.11648/j.ajtas.20160501.11\u003c/li\u003e\n\u003cli\u003eKimberlin CL, Winterstein AG. Validity and reliability of measurement instruments used in research. 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Spine J. 2014;14(1):87\u0026ndash;97. https://doi.org/10.1016/j.spinee.2013.07.463.\u003c/li\u003e\n\u003cli\u003eIyidobi EC, Obande BO, Ekwunife RT. Pattern of MRI findings in patients with low back pain at National Orthopaedic Hospital, Enugu Nigeria. J Biosci Med. 2018;6(4):85\u0026ndash;94. https://doi.org/10.4236/jbm.2018.64009.\u003c/li\u003e\n\u003cli\u003eMiddleton K, Fish DE. Lumbar spondylosis: clinical presentation and treatment approaches. Curr Rev Musculoskelet Med. 2009;2(2):94\u0026ndash;104. https://doi.org/10.1007/s12178-009-9051-x.\u003c/li\u003e\n\u003cli\u003eThapa NB, Bajracharya S. Magnetic resonance imaging findings in patients with low backache. J Soc Surgeons Nepal. 2015;18:11\u0026thinsp;\u0026minus;\u0026thinsp;5. https://doi.org/10.3126/jssn.v18i2.18568\u003c/li\u003e\n\u003cli\u003eLiyew WA. Clinical presentations of lumbar disc degeneration and lumbosacral nerve lesions. International journal of rheumatology. 2020;2020(1):2919625. https://doi.org/10.1155/2020/2919625.\u003c/li\u003e\n\u003cli\u003eSaleem S, Aslam HM, Rehmani MAK, Raees A, Alvi AA, Ashraf J. Lumbar disc degenerative disease: disc degeneration symptoms and magnetic resonance image findings. Asian Spine J. 2013;7(4):322. https://doi.org/10.4184/asj.2013.7.4.322.\u003c/li\u003e\n\u003cli\u003eEkşi MŞ, Turgut VU, Berikol G, \u0026Ouml;zmen BB, Huet SE, Din\u0026ccedil; T, K\u0026uuml;\u0026ccedil;\u0026uuml;ks\u0026uuml;leymanoğlu D, Orhun \u0026Ouml;, \u0026Ouml;zcan-Ekşi EE. Schmorl\u0026rsquo;s nodes could be associated with intervertebral disc degeneration at upper lumbar levels and end-plate disease at lower lumbar level in patients with low back pain. Journal of Clinical Neuroscience. 2022 Jun 1;100:66\u0026ndash;74. https://doi.org/10.1016/j.jocn.2022.04.004.\u003c/li\u003e\n\u003cli\u003eKang HS, Kim T, Oh S, Park S, Chung SH. Intraosseous lipoma: 18 years of experience at a single institution. Clinics in orthopedic surgery. 2018 Jun;10(2):234-9. https://doi.org/10.4055/cios.2018.10.2.234.\u003c/li\u003e\n\u003cli\u003eOzevren H, Cetin A, Baloglu M. Analysis of lumbar disc degeneration: 82 cases. Ann Med Res. 2019;26(12):2784-7. https://doi.org/10.5455/annalsmedres.2019.04.225\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Low back pain, MRI, Lumbar spine, disc degeneration","lastPublishedDoi":"10.21203/rs.3.rs-5898112/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5898112/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the high prevalence of low back pain which impacts the lives of those affected, several studies have explored findings associated with the lumbar spine which is the affected anatomy using magnetic resonance imaging (MRI). This provides a better understanding of the pathology in the study setting and adds to the literature on the subject which is useful during intervention. However, there is a paucity of literature in the Ghanaian context. This study therefore explored the patterns of MRI findings in patients with low back pain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA one-year retrospective cross-sectional design with a purposive sampling method was used to retrieve data from 59 MRI lumbar spine radiologist reports with a clinical history of low back pain. Data was analysed using SPSS v26 and Jamovi 2.5.6. Statistical significance was deduced at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRadiological reports with a history of low back pain accounted for 32.6% of the total (n = 181) reports identified. A male-to-female ratio of 0.74:1 was identified with a mean age of 44.7 ± 16.1 years. Disc degeneration (93.2%, n = 55) and lumbar spondylolysis (76.3%, n = 45) were the two main findings identified as the most prevalent across reports. The lordotic curvatures of patients with low back pain were predominantly normal (74.6% n = 44). Disc degeneration was strongly associated with L4/L5 (V = 0.644).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalent finding identified was disc degeneration frequently located at L4/L5. While this study could be a stepping stone for future research in this context, it provides some level of evidence which could be useful to Ghanaian healthcare providers for more focused assessments and interventions. This targeted approach can enhance diagnostic accuracy and improve treatment outcomes for patients suffering from low back pain, facilitating timely and appropriate management strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e","manuscriptTitle":"Magnetic resonance imaging findings in Ghanaian patients presenting with low back pain: A single centre study ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-04 08:57:43","doi":"10.21203/rs.3.rs-5898112/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-02-04T13:29:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-29T09:42:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-29T09:39:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Imaging","date":"2025-01-24T19:52:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"283edc9a-8a2f-41ad-9228-4431f6adc7c6","owner":[],"postedDate":"February 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-28T16:01:57+00:00","versionOfRecord":{"articleIdentity":"rs-5898112","link":"https://doi.org/10.1186/s12880-025-01680-7","journal":{"identity":"bmc-medical-imaging","isVorOnly":false,"title":"BMC Medical Imaging"},"publishedOn":"2025-04-25 15:57:38","publishedOnDateReadable":"April 25th, 2025"},"versionCreatedAt":"2025-02-04 08:57:43","video":"","vorDoi":"10.1186/s12880-025-01680-7","vorDoiUrl":"https://doi.org/10.1186/s12880-025-01680-7","workflowStages":[]},"version":"v1","identity":"rs-5898112","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5898112","identity":"rs-5898112","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}