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Magnetic resonance imaging of human spine

In my clinical experience, one of the biggest impediments to pain recovery is MRI, CT, or other imaging “evidence” of a structural problem. Patients often come to me utterly convinced that they are doomed to a lifetime of pain because of something that a doctor has seen in an imaging study. This is truly unfortunate because a large body of scientific research suggests that there is not a clear cause and effect relationship between conditions visible on MRI and other imaging (such as disc degeneration, disc bulge, disc protrusion, meniscal tear, osteoarthritis, and other conditions) and pain.

The fact of the matter is that MOST people (even people who are completely free of pain) show some evidence of “structural abnormality” if they are subjected to imaging tests. See the image below for a summary of recent scientific evidence to support this fact. 

Image idea credit Lee Higginbotham.

Citations from the image above:

Back Pain

People seem to be particularly prone to getting stuck on the notion that an “abnormal MRI” explains their back pain. But a recent systematic literature review of 33 scientific studies confirms that a large percentage of people have “abnormal” findings on MRI of the spine but no pain. Data from this study is summarized in the table below.

Degenerative Spine Image Findings in Individuals with NO PAIN

 Age (years)
Image finding20304050607080
Disc degeneration37%52%68%80%88%93%96%

Disc signal loss17%33%54%73%86%94%97%
Disc height loss24%34%45%56%67%76%84%
Disc bulge30%40%50%60%69%77%84%
Disc protrusion29%31%33%36%38%40%43%
Annular fissure19%20%22%23%25%27%29%
Facet degeneration4%9%18%32%50%69%83%

What about other other conditions?

  • 2006 study calls into question the relationship between spinal stenosis and back pain
  • 2017 study calls into question the relationship between spondylolysis (with or without spondylolisthesis) and back pain.