Objective: There are many injuries, mostly to tendons or muscles, which can lead to lower back pain. This study aims to see the critical findings in magnetic resonance imaging in patients with low back pain without radiculopathy, no history of trauma, who did not respond to conservative treatment.

Methods: Between April 2018 and November 2019, 443 patients with LBP who did not respond to conservative treatment were examined using MRI with sagittal T1- and T2-weighted imaging.

Results: Vertebral fractures, infections, pars defects, malignancies, and spinal cord tumors were found in 19.4%. Of thirty-one vertebral fractures identified, twenty-one (67.7%) were new while ten were old. Twenty-seven Pars defects were identified, twelve (44.4%) had spondylolisthesis, seven (25.9%) had undislocated, and eight (29.6%) had only Pars edema. The neoplastic disorder was seen in ten (11.6%), none of whom were suspected before imaging. Benign neoplastic diseases such as hemangiomas / vertebral arteriovenous malformations (AVM) were excluded. Eighteen subjects had a variety of conditions, including six ankylosing spondylitis, two discitis, two large vascular aneurysms, two ovarian cysts, two herniated discs, a sacral regurgitation fracture, a previously unsuspected horseshoe kidney, a ruptured fracture, or a retroperitoneal hematoma.

Conclusion: The majority of patients with LBP are clinically best judged and imaging is usually not required. An MRI scan will detect a large number of abnormalities in patients with symptoms of concern. It is important to identify and separate these smaller patient groups to allow early detection and better management of the underlying disease.

Keywords: Thoracolumbar spine, low back pain, pars interarticularis, vertebral fracture, MRI.

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Dr Aniruddh Dash

Professor and Head of Department, MS Orthopaedics, Department of Orthopaedics, IMS and SUM Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar- 751003, Odisha, India