Standing radiographs to screen severe lumbar disc herniation for timely referral

Objectives The degree of spinal canal compromise in lumbar disc herniation (LDH) influences treatment decisions and outcomes. Although magnetic resonance imaging (MRI) is the gold standard for assessing LDH severity, limited access in primary and secondary care settings maÿ delay diagnosis and referral. This study aimed to examine whether radiological parameters measured on standing 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 diagnosed 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 (