Low back pain (LBP) is the sensation of pain, stiffness or muscle tension between the inferior costal margins and the inferior gluteal folds [1]. Even though LBP is a symptom, chronic LBP is considered as a disorder [2]. Chronic LBP impairs quality of life, causes anxiety/depression, increases work absenteeism, and raises healthcare costs [3]. Thus, the etiology and intensity of acute LBP should be thoroughly examined to prevent chronic LBP and its consequences. Recent studies regarding the etiology of LBP have been focused on intervertebral disc degeneration (IVDD), vertebral end-plate changes (Modic changes), and fatty infiltration in the paraspinal muscles [4]. It is still controversial, whether radiological findings correlate with symptoms in patients with LBP [5].

Recent studies recommended that patients should be carefully selected for surgery according to their radiological findings concordant with their clinical findings [6]. The most relevant radiological findings associated with LBP are severity of IVDD, presence of Modic type I/II changes, and fatty infiltration in the paraspinal muscles [7]. Planning phase, if done thoroughly, would determine the success rates of the spinal procedures. Inappropriate planning could cause failed-back surgery syndrome (FBSS) [8]. Unfortunately, FBSS is observed in 10–40% of the patients who underwent lumbar spine surgeries [9]. Once FBSS presents, success rates of consecutive revision surgeries would degrade to 50%, 30%, 15% and 5% [10].

History taking and physical examination are always the essential cornerstones of patient evaluation. However, proper evaluation of radiological findings would help us to select the appropriate candidates for lumbar spine procedures. A new well-structured radiological scoring system, ‘Mo-fi-disc’ has been developed to better evaluate patients with LBP. The previous study showed that radiological signs had close association with intensity of LBP [11]. However, Mo-fi-disc scoring system is at the crawling phase and requires to be improved.

‘Mo-fi-disc’ scoring system has been developed using three radiological parameters on lumbar spine magnetic resonance imaging (MRI): Modic changes (end-plate changes) (Mo), fatty infiltration in the paraspinal muscles (fi), and IVDD (disc). Vertebral end-plate changes, fatty infiltration in the paraspinal muscles, and IVDD were evaluated using Modic, Goutallier, and Pfirrmann classifications, respectively [[12], [13], [14], [15]]. All those classified parameters have been quantified according to their association with LBP based on the literature [[16], [17], [18], [19], [20]]. It has been shown that each 1-score increase in ‘Mo-fi-disc’ score predicted a 19% increment in visual analogue scale (VAS) scores in patients with LBP [11]. Even though ‘Mo-fi-disc’ scoring system predicted the intensity of LBP, its predictivity for LBP-related disability is unknown. Low back pain is a disabling condition since it impairs both quality of life and productivity in affected subjects [21].

Future of healthcare is oriented towards a more digitalized, artificial intelligence (AI)-based analytics for assessment and treatment of diseases and disorders. To develop such instruments, more developmental steps should be taken. In the present study, we aimed to analyze whether ‘Mo-fi-disc’ scoring system could reliably predict LBP-related disability as it did for intensity of LBP.