Assessment of Lumbar Foraminal Stenosis: Diagnostic Value and Clinical Correlation: A Systematic Review.

Introduction: Lumbar foraminal stenosis (LFS) is a recognized source of radiculopathy and chronic low back pain, yet the relationship between radiological severity and clinical presentation remains uncertain. Although magnetic resonance imaging (MRI) is routinely used to evaluate foraminal narrowing, imaging findings frequently do not parallel symptom burden. This systematic review examined the diagnostic value of imaging modalities and the strength of radiological-clinical correlation in LFS. Materials and Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Science Direct and Cochrane Library databases were searched up to May 2025. Randomized controlled trials, cohort studies, and observational studies involving adult patients with lumbar or foraminal stenosis assessed using MRI or computed tomography were included if correlations between imaging findings and clinical outcomes were reported. Study selection and data extraction were performed independently by two reviewers. Risk of bias (RoB) was assessed using RoB 2 and RoB in non-randomized studies - of interventions tools, and overall certainty of evidence was graded using the grading of recommendations assessment, development and evaluation framework. Results: Twelve studies involving 1,133 patients were included in the study. A moderate correlation (r = 0.3-0.6) was observed between imaging severity and pain intensity. Severe stenosis grades demonstrated sensitivity ranging from 60% to 85% and specificity from 70% to 90% for symptomatic cases. However, several studies reported poor correlation between MRI grading and disability scores or walking capacity. Foraminal cross-sectional area below 40-50 mm2 was associated with increased symptom likelihood. The sedimentation sign showed high diagnostic specificity. Interobserver reliability was strong for disk morphology but only moderate for nerve root compression. Study heterogeneity limited pooled interpretation. Conclusion: Imaging findings demonstrate only moderate alignment with clinical severity in LFS. MRI should be interpreted alongside functional assessment and clinical evaluation rather than in isolation. A multidimensional diagnostic approach is necessary to guide appropriate management.