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Low Back Pain and MRI'S - Part I

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Technological advances in diagnostic imaging (Xrays, CT scans, MRI’s) are incredible. However, our ability to see inside the body is greater than our ability to interpret what that information means to our pain. An MRI of a lumbar spine in a person over the age of 60 is going to show “pathology” such as herniated discs, spinal stenosis, arthritis, etc. BUT, these findings on the MRI can be “normal” age related changes and are not necessarily causing your pain. Some have termed them “wrinkles on the inside”. It seems reasonable for a person with right-sided low back pain and an MRI that shows some degenerative changes at L4-5 on the right to believe that those pathological changes are causing the back pain. But that is not necessarily the case. One study (1) looked at MRI’s of asymptomatic people (no back pain) over the age of 60 and found 36% had a herniated disc, 21% had spinal stenosis and over 90% had a degenerative or bulging disc. Another study (2) looked at MRI’s of asymptomatic people and then another MRI if the person developed low back pain within 5 years. 90% of the asymptomatic people had findings on their MRI even though they had no low back pain. Of the people that went on to develop low back pain, 84% had MRI’s that looked the same or better after the symptoms developed compared to before. So, in other words, what the MRI shows and what the person feels are not strongly correlated. Note – this article is about low back pain in people that are not surgical candidates and people that have no red flag signs or clinical features that indicate something really serious is going on

1. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. Journal of Bone and Joint Surgery America. 1990; 72: 403-408.

2. Carragee E, Alamin T, Cheng I, Franklin T, vanden Haak E, Hurwitz e. Are first-time episodes of serious LBP associated with new MRI findings? Spine Journal. 2006;6:624-635.

3. Flynn TW, Smith B, Chou R. Appropriate use of diagnostic imaging in low back pain:A reminder that unnecessary imaging may do as much harm as good. Journal of Orthopaedic & Sports Physical Therapy. 2011; 41:838-846.

Matt Seltzer