Authors: Research Scholar Badal Biswas, Associate Professor Dr. Jagat Bahadur Rawat
Abstract: Selecting the right patient is the most important determinant of benefit from lumbar decompression, yet degenerative findings on magnetic resonance imaging (MRI) are common in people without symptoms. In published pooled estimates, disc bulges are present in 30% of asymptomatic people at age 20 and 84% at age 80, and disc protrusions in 29% and 43%. Imaging alone therefore cannot establish that a compressed nerve root is the source of a patient’s symptoms. This paper presents a patient-selection framework for nerve root compression and radiculopathy that combines a red-flag safety gate with structured clinical localisation and a clinical–imaging concordance score. The score rates four elements—level, side, symptom pattern and neurological signs—from 0 to 2 each, giving a total of 0–8 that is graded as high (7–8), partial (4–6) or low (0–3) concordance, and each grade is linked to a defined action. A root-level localisation table supports consistent clinical examination. The framework is a proposed design derived from a doctoral thesis; it reports no patient data, and its reliability and predictive value remain to be tested.
