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MRI for Back Pain: What Your Results Really Mean

“The result of my MRI for back pain says I have degenerative disc disease.”

It was 15 minutes before 8:00 in the morning…15 minutes before my office opens.

Already at the door is my first patient, a 59-year-old middle-school teacher, waiting for me to let her in.

A panicked expression flittered across her face as she handed me a paper and a computer disc, revealing the diagnosis of the MRI for her back pain.

As I led her to my office, she looked away and delicately pinched the bridge of her nose as she ran her hand through her hair and closed her eyes.

While looking at the images of her MRI result on my computer, I could see an icy panic crept up her extremities as she drummed her fingers on my office table.

Finally, her chest rose as she drew in a long breath and ask me several questions in rapid succession…

“What am I ‘gonna do?”

“Is that something that would heal?”

“Am I going to have back pain for the rest of my life?”

Have you had a similar experience when you first read the diagnosis written on your medical imaging, be it from an MRI, X-ray, or CT scan?

And, it was made especially scary when your doctor added…

“You have the worst MRI I have ever seen.”

Or, ” The X-ray of your back looks like that of an 85-year-old!”

And you are just 55… or 65-years-old!

The diagnoses commonly seen in medical imaging results (X-rays, MRIs, CT scans, etc.) scare patients and cause a lot of stress and anxiety for many people.

Not knowing the meaning of the diagnosis on your medical imaging can produce an unpleasant feeling triggered by the perception of danger, whether real or imagined.

In this article, I will help you understand the meaning of the different diagnoses commonly seen in MRI (or X-ray and CT scan) results.

Find out what your specific diagnosis means and look into the research and evidence in this article so you can make an informed decision on how to manage your back pain.

Common Diagnoses Seen in MRI for Back Pain Results (or X-ray, CT scan, etc.)

Medical Imaging

When seeing a doctor for back pain, it is common for the doctor to order a medical imaging test. These tests, including magnetic resonance imaging (MRI), X-ray, or computerized tomography (CT) scan, usually show some sort of abnormality or disease, or injury.

These are the common diagnoses seen in medical imaging results for back pain:

  • Bulging Disc
  • Herniated Disc
  • Spinal Stenosis
  • Vertebral Stenosis
  • Slipped Disc
  • Slipped Vertebra
  • Degenerative Disc Disease

 

Bulging and Herniated Disc

bulging disc

In 1999, an MRI study of the lumbar spine (low back) was performed to examine the changes in the volume of fluid inside the intervertebral disc.

What the researchers found was that the vertebral disc has more fluid in it in the morning than in the afternoon or at night. 

The reason?

You are lying down during the night when you sleep and your body is not moving much so your vertebral discs end up with more fluid in them in the morning. The MRI for back pain shows this increased fluid as a bulging disc.

Have you ever wondered if your doctor considered the time of day your MRI was taken?

Did your doctor consider the implication of your position (lying down or sitting up) when your MRI was taken?

Fluid accumulation in your disc does not necessarily cause more pain or disability.

Even people who do NOT suffer from back pain can be affected by bulging discs!

In spite of how scary it may sound, herniated discs are not as scary as you think. It is quite similar to other soft tissue injuries, such as a wrist injury or ankle sprain – there is internal bleeding, inflammation, and swelling.

Your MRI for back pain result will show the extra fluid caused by the bleeding, inflammation, and swelling. We know this condition as herniated discs.

Over time, the swelling, bleeding, and inflammation associated with an injury like a sprained ankle or wrist or a herniated disc will disappear as the body recovers and heals.

Spinal or Vertebral Stenosis

MRI

In spinal or vertebral stenosis, the canal where the nerves from your back pass through narrows and may result in a compression of the nerves. As a result, the nerves may have difficulty sending information.

Do you think that the diagnosis of spinal or vertebral stenosis found in your MRI result is the cause of your back pain? 

In 2005, a group of scientists took MRI pictures of people over the age of 40.

Was there anything visible in the imaging pictures?

The stenosis on the MRI results they studied was present in only 25-50% of the subjects reporting back pain.

According to the study, not all back pain sufferers have spinal stenosis.

A “positive” diagnosis of spinal or vertebral stenosis in the subjects’ MRI should have been observed in all the subjects of the study if spinal stenosis were a key factor in back pain.

Most of the subjects that had “positive” spinal stenosis in their MRI results did NOT report back pain.

Moreover, when people get into their 60’s or older, MRI results reveal that most people have “positive” spinal stenosis.

Yet, most of them do NOT report back pain.

Slipped Disc or Slipped Vertebra

slipped disc

Often referred to as slipped vertebrae, spondylolisthesis occurs when one vertebra slips forward or backward and out of place in relation to the vertebrae above or below it.

A slipped vertebra, like a slipped disc, often occurs in the lower back.

What you may find interesting is that in many cases, people without back pain will show slipped vertebrae in their imaging. While many people who have back pain, do NOT have slipped vertebrae in their MRI results.

Another group of scientists took diagnostic imaging pictures of elite teenage tennis players in 2007.

Can you guess what the pictures of the imaging show?

According to their MRI scans, one in three players had slipped vertebrae

At the time the MRIs were taken, each of those tennis players was actively playing and competing at their highest level.

There was not a single player who complained of back pain.

Degenerative Disc Disease

degenerative disc disease

All of our tissue, including bones, muscles, ligaments, and discs, ages as we get older. As discs age, they thin out.

Disc degeneration is not a disease.

Rather, it is a natural process that happens to everyone.

It is common for the disc’s outer layers to dry out and wear away, sometimes creating holes in the disc. With aging, the inner part of the disc bulges or ruptures outward. 

Sometimes, some vertebrae wear down due to aging, putting nerves at greater risk of being impinged by bone spurs (osteophytes).

We call this “degenerative” because it means our spine degenerates over time – just like the rest of our bodies.

Changes associated with aging, including degenerative disc disease, are not directly linked to back pain.

If it is the case, then everyone over 20 should have back pain, AND no one below 20 should have back pain.

Your MRI pictures may show changes to your spine, called degenerative disc disease. That happens with age. 

It does not mean you will be in pain or you will be restricted in your activities. 

 

Conclusion

As my patient heard the studies I shared with you in this article, she unclenched her fists and rested her hands down on my table. A relieved look washed over her face.

Finally, she flashed a huge grin at me and asked… “So, I was all worried and worked up for nothing then?”

“I’m afraid you are not the only one,” I assured her with my answer.

It can be scary to hear your doctor say that you have a slipped vertebra, a bulging disc, a herniated disc, spinal stenosis, or a degenerative disc disease and not know what it means for the future of your health and function.

The truth is that there is no relationship between what your medical imaging pictures show and how you feel or function.

Dr. David Hanscom, a renowned orthopedic spinal deformity surgeon and author of Back in Control: A Surgeon’s Roadmap Out of Chronic Pain, has this to say about imaging results and surgery:

“We generally don’t know where back pain comes from exactly.”

“We do know very clearly that disc degeneration has nothing to do with back pain. So conditions such as arthritis, bone spurs, bulging, herniated, “slipped” or ruptured discs are rarely the underlying cause of the problem.”

This is where spinal surgery – probably about 70 percent of it should not be done.

Yet in the United States, we are probably doing between 400,000 and half a million spinal fusions a year – with a success rate of only about 20-40 percent.

In this article, I share six powerful reasons you need to consider before getting spinal surgery.

MRI for back pain is NOT an accurate predictor of pain.

Many people who suffer from severe pain have completely normal MRIs and…

Many people who have abnormal MRI results experience no pain at all.

Frequently Asked Questions

What is a lumbar MRI?

Lumbar MRIs are non-invasive procedures that can help doctors diagnose back pain, plan back surgery, or follow progressing medical conditions.

A typical scan takes between 20 and 45 minutes. The procedure is painless and very few risks or side effects are associated with it.

What are the reasons I cannot get an MRI for back pain?

As far as MRI scanning is concerned, there are several absolute contraindications:

  • Cardiac Pacemakers
  • Ear or Cochlear implants
  • Drug Infusion Pumps, i.e. insulin delivery, analgesic drugs, or chemotherapy pumps
  • Magnetic Dental Implants
  • Metallic fragments such as bullets, shotgun pellets, and metal shrapnel
  • Artificial Limbs
  • Piercing

Other than the absolute contraindications, there are also several relative contraindications; meaning, extra caution or evaluation is needed prior to getting an MRI for back pain:

  • Cardiac or peripheral artery stents
  • Intrauterine Device (IUD)
  • Implanted staples
  • Surgical clips or wire sutures
  • Tattoos of less than six weeks old
  • Colonoscopy in the last eight weeks

Will MRI for back pain show my back problems?

An MRI is not a standard test for identifying the cause of low back pain. In most cases, a physical examination that includes questions about your medical history is enough to diagnose and treat your condition.

Because acute cases of low back pain usually improve on their own or with conventional medical or physical therapy treatments, it’s best to wait and see if your back pain resolves itself on its own.

MRIs may overdiagnose back problems and lead to invasive and often unnecessary treatments. 

MRI should only be used in cases where it is clearly indicated, such as in conditions accompanied by clear warning signs, such as weakness of the extremities, history of cancer, fever, infection, or loss of bowel or bladder control. Or if you suffered from a traumatic injury, such as a fall or car accident.

Dr. Lex Gonzales
Dr. Lex Gonzales, PT, DPT is an author and speaker who has been working as a licensed healthcare professional for over 24 years. On drlexgonzales.com he provides quality information and practical solutions you can use to achieve the best version of your healthy self.

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