It is well documented that back pain is the most common cause of missed work and the second cause of physician visits in the United States. Annual costs of well in excess of 100 billion dollars. Lumbar spine MRI scans are commonly ordered to assess the origin of pain and determine structural abnormalities of the spine.
Lumbar spine MRI is considered the test of choice to evaluate disc pathology. However, the test has many false positives and will often show abnormalities that are incidental and have no correlation with the true cause of pain. This is demonstrated in a well-designed MRI study that evaluated 98 patients that were asymptomatic (no low back complaints). MRI scanning was performed on these patients and read by two different neuro-radiologists. Of the patients examined, 36% had normal disc findings at every level. In the remaining patients, 52% had a disc bulge at at least one level and 27% had a disc protrusion. There were 38% of the participants that had an abnormality of more than one disc level. Annular defects defined as disruption of the annulus was seen in 14% and facet degenerative arthropathy was seen in 8% of the participants. There was no difference between men and women.
This study confirms the presence of pathology in the majority of asymptomatic participants. What this means to our patients is that the history and physical exam findings must be correlated with the MRI to determine if abnormalities on the MRI scan are actually clinically relevant. A thorough discussion of findings on the MRI is an absolute so that there is no confusion regarding the relevance of the findings. All too often, I will have patients who come to the office and say that “their discs are degenerating” and also state “I have three bulging discs” as the source of their pain. More often than not, these findings are not clinically significant and have no bearing on our treatment plan.
Lumbar MRI results can be very helpful, but also very confusing. A thorough discussion with your medical provider can clarify definitions and also address the clinical relevance of the findings.
Click this link to read the entire ARTICLE.
Magnetic Resonance Imaging of the lumbar Spine in People Without Back Pain-N.C. Jensen, et al.
New England Journal of Medicine 1994; 331-69-73.
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