BRIEF RESEARCH REPORT article
Front. Musculoskelet. Disord.
Sec. Spine Conditions
This article is part of the Research TopicHighlights in Spine ConditionsView all 8 articles
Standing Radiographs to Screen Severe Lumbar Disc Herniation for Timely Referral
Provisionally accepted
- 1Lerdsin Hospital, Bangkok, Thailand
- 2Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
- 3University of Liverpool, Liverpool, United Kingdom
- 4Bumrungrad International Hospital, Bangkok, Thailand
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Objectives: The degree of spinal canal compromise in lumbar disc herniation (LDH) influences treatment decisions and outcomes. Although MRI is the gold standard for assessing LDH severity, limited access in primary and secondary care settings may delay diagnosis and referral. This study examined whether radiological parameters measured on standing whole-spine radiographs are associated with MRI-defined LDH severity and could support timely referral for advanced imaging. Methods: This retrospective cross-sectional study included patients with LDH who underwent both standing whole-spine radiographs and lumbar MRI between June 2014 and January 2024. Radiographic parameters assessed were disc height index (DHI), pedicle width-to-sagittal vertebral body width ratio (PW:SBW), pelvic incidence (PI), lumbar lordosis (LL), and sagittal vertical axis (SVA). Canal compromise was quantified on MRI and classified as mild (<50%) or severe (≥50%). Associations between radiographic parameters and severe canal compromise were evaluated using binary logistic regression and receiver operating characteristic (ROC) curve analysis. Results: An SVA ≥50 mm was independently associated with severe canal compromise (odds ratio 3.376; 95% confidence interval 1.658–6.877). The optimal SVA cutoff was 52 mm, with a sensitivity of 41% and specificity of 83%. Other radiographic parameters were not significantly associated with LDH severity. Conclusions: SVA measured on standing radiographs is associated with MRI-defined severity of LDH but demonstrates limited discriminatory performance. It should not be used as a screening or exclusion tool; however, SVA may provide adjunctive information to support clinical assessment and MRI referral decisions in selected patients, particularly in resource-limited settings. Prospective validation is required.
Keywords: Lumbar disc herniation (LDH), MRI referral, sagittal vertical axis (SVA), Spinal canal compromise, Standing radiographs
Received: 01 Nov 2025; Accepted: 10 Feb 2026.
Copyright: © 2026 Surapuchong and Pongpirul. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Krit Pongpirul
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.