Have you been told you have a disc bulge at L4-L5? Has another healthcare provider told you that you will likely need surgery? That you will not be able to perform some activity ever again because of the image that was taken?
Patients will sometimes come into physical therapy practices bringing with them the results of their magnetic resonance imaging (MRI) and are afraid of their prognosis. Sometimes patients will even be seeking MRIs because of their pain.
But do spinal MRIs matter?
MRIs are a useful tool for visualizing soft tissue structures and potential pathologies. However, a 2015 study published in the American Journal of Neuroradiology by Brinjikji et al. found that MRI imaging will show disc bulges and herniations in the lumbar spine of individuals WITHOUT low back pain.
A systematic review of 3,110 asymptomatic individuals (people without low back pain) found after taking MRI imaging that lumbar disc pathology (bulges, herniations, degeneration) were observed in roughly 30% of 20-year-old individuals, increasing almost 10% every decade of life, to roughly 90% of 80-year-old individuals with disc pathology.
So does everyone in this study who had a lumbar disc pathology need surgery when they didn’t have low back pain? If one of the 30% of 20 year-olds with a positive disc pathology on the MRI develops low back pain in the future is his pain because of the disc pathology or something else unrelated?
The authors of this study concluded that: “imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. These imaging findings must be interpreted in the context of the patient’s clinical condition.”
What does this mean?
It means that if a patient has signs and symptoms consistent with a disc pathology and the MRI also demonstrates the same finding then the result is meaningful. However, disc pathology observed on MRI is also likely a natural part of aging and DOES NOT necessarily mean it is the cause of pain.
So how can you find if your symptoms are related to disc pathology?
A physical therapist can! Physical therapists perform an evaluation using clinical tests, measurements, and by interpreting your symptoms to diagnose whether you have a disc injury. And yes, disc pathology is treatable through physical therapy as well!
So do you always need an MRI if you have low back pain?
No!
Go see your local physical therapist and see how they can help you!
By Steve Kozuch, PT, DPT
Call our office TODAY at 703-450-4300 and start handling your aches and pains FOR GOOD!
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Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173
Free article link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/
