MRI’s and Back Pain

We typically have patients come into our office with stacks of MRI, CT Scans and x-rays to confirm the label of Degenerative Disc Disease placed on them by other medical professionals. For example, a woman once came into our office. She had in essence become the living, breathing “embodiment,” of the problem that showed up on her film. When she came in, all she could do was talk about her degenerative disc disease. This woman had pain in her groin and her back. When we told her we were going to examine her to determine if this was indeed her problem, she had a lot of difficulty comprehending that her pain may not come from her Degenerative Disc Disease at L-5, S-1 because she had already been diagnosed as needing surgery. There have been many studies and papers written on the accuracy or correctness of diagnosis based on an MRI reading.

We know from studies that half the people after a certain age show disc problems on film but they reported they had no pain.

So if someone has a diagnosis from an MRI the first thing we do is see if that is REALLY where the pain is coming from. To practice good medicine we need to rely on MRI, x-ray and CT scans. But we also need to use our hands to find out where the pain is coming from, being careful to gently press on the suspect area causing pain. When the physician’s touch elicits an intense pain spot, known as a trigger point or tender point, this may be a good area to do Prolotherapy.

MRIs and First-Time Episodes of Serious Low Back Pain
Researchers writing in The Spine Journal examined the relationship between new and serious episodes of low back pain and findings on MRI

The researchers noted: “Magnetic resonance (MR) imaging is frequently used to evaluate first-time episodes of serious low back pain (LBP). Common degenerative findings are often interpreted as recent developments and the probable anatomic cause of the new symptoms. ”

The researchers studied “200 subjects with a lifetime history of no significant low back pain problems, and a high risk for new low back pain episodes,” over a 5 year period.

Their results showed: “During the 5-year observation period of 200 subjects,51 (25%) subjects were evaluated with a lumbar MRI for clinically serious LBP episodes, and 3/51 (6%) had a primary radicular complaint.

These 51 subjects had 67 MR scans. Of 51 subjects, 43 (84%) had either unchanged MR or showed regression of baseline changes. The most common progressive findings were disc signal loss (10%), progressive facet arthrosis (10%), or increased end plate changes (4%). Only two subjects, both with primary radicular complaints, had new findings of probable clinical significance (4%).

They concluded: “Findings on MR imaging within 12 weeks of serious LBP inception are highly unlikely to represent any new structural change. Most new changes (loss of disc signal, facet arthrosis, and end plate signal changes) represent progressive age changes not associated with acute events. Primary radicular syndromes may have new root compression findings associated with root irritation.”

Carragee E, Alamin T, Cheng I, Franklin T, van den Haak E, Hurwitz E. Are first-time episodes of serious LBP associated with new MRI findings? Spine J. 2006 Nov-Dec;6(6):624-35.

Questions about this article? Contact Dr. Darrow