Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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MD, DM (Clinical Pharmacology)
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Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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C.S. Ramesh Babu,
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Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : January | Volume : 16 | Issue : 1 | Page : TC15 - TC18 Full Version

Correlation between Pain, Disability and Levels of Disc Herniation in Michigan State University Grade-3 Disc Prolapsed Patients using Magnetic Resonance Imaging: A Cross-sectional Study


Published: January 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52935.15871
Qurain T Alshammari, Leo Rathinaraj Antony Soundararajan, Sreeja Mannickal Thankappan, Meshari T Alshammari

1. Dean-Academic Affairs, College of Applied Medical Sciences, Department of Diagnostic Radiology, University of Hail, Hail, Saudi Arabia. 2. Lecturer, Department of Physical Therapy, University of Hail, Hail, Saudi Arabia. 3. Lecturer, Department of Anatomy, University of Hail, Hail, Saudi Arabia. 4. Lecturer, Department of Diagnostic Radiology, University of Hail, Hail, Saudi Arabia.

Correspondence Address :
Dr. Leo Rathinaraj Antony Soundararajan,
Lecturer, Department of Physical Therapy, College of Medical Applied Sciences,
University of Hail, Hail, PO Box: 2440, Pincode-81481, Saudi Arabia.
E-mail: leo_rathinaraj@yahoo.com

Abstract

Introduction: Sciatica is considered as a pain with radiation from the back to the dermatome of the nerve root which gets compressed. Clinical decision making for the diagnosis and treatment of the patients with sciatica need the support from the imaging of the spine. Magnetic Resonance Imaging (MRI) is the best modality for screening the spine.

Aim: To identify the relationship between pain, disability and levels of disc herniation in grade-3 disc prolapsed patients.

Materials and Methods: The present study was a cross-sectional study, which was conducted in the King Khalid Hospital, Hail, Saudi Arabia from November 2019 to May 2020. In this study, 57 patients were included and their consent was obtained. Patients reported their intensity of back and leg pain in Visual Analogue Scale (VAS) and recorded their disability in the Roland Morris Disability Questionnaire (RMDQ-Arabic version). Clinical examination of the spine and the lower extremity was done, followed by MRI for all the patients. The degree of the disc displacement and nerve root compression was graded according to the Michigan State University (MSU) classification of disc herniation. Documented data was statistically analysed using Statistical Package for the Social Sciences (SPSS) 20.0 version with the Pearson’s correlation.

Results: Correlation between the pain intensity (VAS), Functional Disability (RMDQ) and grade-3 disc herniation in MRI were measured with Pearson correlation coefficient. Grade-3 disc herniation had weak correlation with pain intensity (r=-0.147) and also with functional disability (r=0.155). In these patients, pain intensity and functional disability also showed weak correlation disability (r=0.293).

Conclusion: Level of the disc herniation shows weak correlation with both intensity of pain and functional disability; thus, it is advisable to correlate the clinical symptom of the patients with MRI to decide the therapeutic intervention.

Keywords

Dysfunction, Impairment, Intervertebral disc prolapse, Low back pain, Radiodiagnosis

Low back pain affects approximately 80% of the population once in their lifetime and around 80% of the reason for this back pain is due to the structural changes due to intervertebral disc (1). Disc herniation or Intervertebral Disc Prolapse (IVDP) is usually considered as a multifactorial mechanical derangement often related to the degeneration of the disc and may be due to poor posture or by external trauma of the spine especially during spinal flexion or rotation exercise and stretching of the back (2). Throughout the world, degenerative disc disease is the most frequently known cause for low back pain (3). Normally, negative pressure increases the hydration of the intervertebral disc and decreases pressure on the nerve root by removing the compression on the vertebral pulp (4). Neuromuscular system plays a vital role in maintaining the stability of the spine as well as for the normal biomechanics of the lumbar spine (5),(6). In low back pain, weakness and fatigue of the back muscle as well as decreased mobility of the spine leads to pain and disability (7),(8). Thus, for the normal function of the spine, adequate contraction of the trunk muscle, balance between agonist and antagonist muscles and coordination of the structures around the spine is important (8),(9). Alteration in the muscular stabilisation ends in reduction of force to support the spine thus increases the risk of further injury to the spinal structures (6). In IVDP, sciatic pain is responsible for the dysfunction in the lumbar spine, as these pain delays the onset of back muscle contraction (9).

MRI is one of the gold standard tools to evaluate the disc degeneration and intervertebral disc pathologies especially in dehydration, herniation, Schmorl’s nodes and inflammatory changes in the endplates (10),(11),(12). MRI is the excellent radiodiagnostic machine to assess the relationship of intervertebral disc with the surrounding soft tissues and neural structures (13). Though, it is usually done to identify the pathology in the soft tissues around the spine, it is also helpful to detect the pathologies in the spinal canal and cord (14). In IVDP patients, to have a complete evaluation of the problem and to judge the appropriate treatment, a valid objective measure as well as a standard scale is needed to grade the disc herniation (15). MRI data specifies the shape, size, extent and location of the disc and the outcome of the IVDP patients and mostly depends on the size and location of the prolapsed disc within the spinal canal. It is documented that central disc extrusion and protrusion are less symptomatic than centrolateral or lateral lesions (16). Herniated disc of same size may be symptomatic in some patients whereas asymptomatic in some other (17). Thus, to avoid the misinterpretation of the abnormal MRI images in asymptomatic patients, clinical correlation is always essential before treating them (18).

The aim of this study was to find the correlation between level of disc herniation with pain and disability amongst patients with severe disc prolapse.

Material and Methods

This was a cross-sectional study carried out in the Department of Radiology of King Khalid Hospital, Hail, Saudi Arabia from November 2019 to May 2020. The research protocol was submitted to the Institutional Ethical Committee (King Khalid Hospital, Hail) and the approval was obtained before starting the research (KKH-RAD-2019-017-80 dated 14.09.2019). Information about the nature, procedure, risks and benefits of the research was given and written consent was obtained from all the study participants.

Inclusion criteria: Only grade 3-disc herniation patients as described by the MSU classification were included (19). Both sexes, aged between 20-50 years, with ability to participate in the study without cognitive impairments were included in the study.

Exclusion criteria: Patients with any aetiology for their low back pain such as spinal deformities: scoliosis, kyphosis, spondylolisthesis, cancer, spinal injuries, trauma, fracture in the spine, ankylosing spondylitis, visceral problems, pregnancy and myofascial pain were excluded from this research. Patients receiving corticosteroid treatment in the last six months were also excluded.

Sample size calculation: The sample size calculation for the correlation was performed using G power 3.1.9.7 software. Considering an alpha of 0.05, a power of 0.80, calculated effect size for the model was 0.43, with a required sample of 38 individuals. For this study, a total of 57 patients with low back pain referred for MRI scan of lower back were included.

Study Procedure

Participants were assessed at baseline by an investigator, the severity of pain, functional disability and the extent of disc herniation.

Pain: Pain was assessed using a VAS, consists of a 10 cm line, with the left extremity indicating “no pain” and the right extremity indicating “unbearable pain.” Participants were asked to use the scale to indicate their current level of pain. Higher values suggest more intense pain (19).

Functional disability: Functional disability was estimated by the RMDQ, a functional scale to assess the impact of low back pain on daily activities. Though there are many functional questionnaires available for the measurement and evaluation of low back pain, RMDQ was appropriate for this study ([Valid Arabic version available for better understanding of the study population) (20). The subjects were asked to tick a statement which suits their symptoms during a functional activity. The end score was calculated by just adding all the ticked boxes. The score ranges from 0 (no disability), 11 (mild), 18 (moderate) or 24 (severe).

Magnetic Resonance Imaging (MRI): All the patients underwent MRI diagnostic imaging in the supine lying using the 1.5 T MRI machine (Avanto; Siemens, Erlangen, Germany) with a 24-element body spine surface coil.

The MRI protocol consisted of sagittal and axial T1 and T2 weighted sequences with turbo spin echo. The procedure used as follows: T1-sagittal weighted sequences (slice thickness, 3.0 mm; intersection gap, 1.0 mm; matrix size, 320×320; field of view, 32×32 cm; TR/TE, 400/8 ms), T1- axial multistack and angle (slice thickness, 3.0 mm; intersection gap, 1.0 mm; matrix size, 320×320; field of view, 25×29 cm; TR/TE, 400/15 ms), T2- sagittal weighted sequences (slice thickness, 3.0 mm; intersection gap, 1.0 mm; matrix size, 320×320; field of view, 32×32 cm; TR/TE, 4700/100 ms), T2-axial weighted sequences (slice thickness, 3.0 mm; intersection gap, 1.0 mm; matrix size, 448×225; field of view, 25×19.5 cm; TR/TE, 4,600-5,150/100-110 ms), T2-STIR sagittal (slice thickness, 3.0 mm; intersection gap, 1.0 mm; matrix size, 320×320; field of view, 32×32 cm; TR/TE, 4000/110 ms), T2-axial multistack and angle (slice thickness, 3.0 mm; intersection gap, 1.0 mm; matrix size, 265×265; field of view, 25×290 cm; TR/TE, 3000/100 ms) (Table/Fig 1).

Evaluation and interpretation of the MRI changes (L1 to S1) was performed by two experienced musculoskeletal radiologist using standardised evaluation protocols. MSU classification (21) was used as an objective measure of lumbar disc herniation on MRI (Table/Fig 1).

Statistical Analysis

The SPSS version 20.0 for windows (SPSS Inc., Chicago, IL, USA) was used to perform the statistical analysis. Mean and the Standard Deviation (SD) of age, duration, height, weight, VAS and disability score was taken in all the patients. Pearson’s correlation coefficient was done to find the correlation between the variables.

Results

In this study, 57 patients with grade-3 disc herniation were evaluated and there were 30 males (52.6%) and 27 females (47.4%). The mean age of the patients was 36±8.1 (range: 20-50-years) (Table/Fig 2). There were 18 males and 20 females in 41-50 years age group (Table/Fig 3).

Among the 3 types of level 3-disc herniation of MSU Classification, the prevalence of AB type was high in present study subjects with the 26 patients (45.6%) followed by the type B herniation with 21 subjects (36.8%). Only 10 subjects (17.6%) were there with type A herniation.

There was no significant relationship between the level of lumbar disc herniation and sex of the patients (p=0.567). Mean VAS score of these patients were 8±1 (range: 1-10), whereas the mean RMDQ score was 16±2 (range: 12-23). Pain intensity measured with VAS score in the patients with L4-L5 level and L5-S1 level disc herniation is shown in (Table/Fig 4).

Grade-3 disc herniation had weak correlation with pain intensity (r=-0.147; p=0.001) and also with functional disability (r=0.155; p=0.001). Pain intensity also had weak correlation with functional disability (r=0.293; p=0.02) in severe low back pain patients (Table/Fig 5).

Discussion

In the present study, clinical symptom such as pain and disability in grade-3 disc herniation patients and its clinical correlation with the MRI findings was evaluated to determine the clinical importance of anatomical abnormalities identified by this radiographic technique. Not like the previous research works (22),(23),(24) which included only males, this study included both males and females. Low back pain and sciatica may develop as a result of disc degeneration and its cause may be multifactorial, which includes age-related changes, physical activity and their medical history (25). With respect to the body mass index, subjects with overweight had 5.7 times higher risk of getting low back pain when compared to normal subjects (26). Similarly, lifestyle also contributes in developing low back pain. A study showed that people who engaged in mild activity had more chances of getting low back pain than the one who did strenuous activity (26).

In this demographic study, clinical and MRI parameters has weak correlation with the pain intensity and disability in both male and female. It had been documented in an autopsy study of 647 lumbar spine that the disc degeneration is common in L4-L5 level (27), present study also observed similar findings. This usual presence of pathology at L4-L5 is not as high as noted in the previous research (28). In low back pain, pain intensity influences the functional disability but, in this study, there was a weak correlation observed between the characteristic of pain and disability. This might be because of the young age group participants. In a study, it was found that pain intensity is a major variance to predict the disability among chronic low back pain (29). To measure the severity of the back pain, disability is the best clinical evaluation tool. It also helps us to analyse the transformation of pain from acute to chronic stage (30) and acts a determinant of function such as return to work (31). Sometime disc herniation can lead to more clinical symptom and higher incidence of disability (32). This study found a weak correlation between the pain intensity and disability, which was in contrast to the previous research reported correlation of disability not only with pain intensity but also with other factors such as depression, fatigue, psychosocial factor, financial status and unemployment (33). Disc protrusion and bulges were found to be highest in the 5th and 6th decade (34), but in present study it was in the 4th decade, this may be due to the limitation of the subjects’ age.

Limitation(s)

The limitation of the present study was that body mass index, psychosocial factors such as depression, anxiety, financial status, smoking habits etc., were not evaluated. Also, asymptomatic subjects (control group) were not assigned.

Conclusion

Level of disc herniation is frequently understood as the reason behind pain and disability. But this study shows that the grade-3 disc herniation in lumbosacral spine had weak correlation with both pain intensity and functional disability among patients with severe low back pain. Thus, authors encourage the clinicians to correlate the level of disc herniation in MRI with the clinical symptoms of the patients with low back pain.

References

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Weiler C, Lopez-Ramos M, Mayer HM, Korge A, Siepe CJ, Wuertz K, et al. Histological analysis of surgical lumbar intervertebral disc tissue provides evidence for an association between disc degeneration and increased body mass index. BMC Res Notes. 2011;4:497. [crossref] [PubMed]
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Jung OH. The effects of traditional physical therapy on pain reduction and depression level of patients with chronic low back pain. 2000. Dan-kook University, Dissertation of master's degree.
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Gill K, Gallaghan M. The measurement of lumbar proprioception in individuals with and without low back pain. Spine. 1998;23:371-77. [crossref] [PubMed]
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DOI and Others

DOI: 10.7860/JCDR/2022/52935.15871

Date of Submission: Oct 19, 2021
Date of Peer Review: Dec 04, 2021
Date of Acceptance: Dec 23, 2021
Date of Publishing: Jan 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 22, 2021
• Manual Googling: Nov 09, 2021
• iThenticate Software: Dec 21, 2021 (11%)

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