Why are MRI words so scary?
By Rachel Botkin, PT
Introduction
Experiencing low back pain can be a challenging and distressing issue, particularly as we age. Your physician may decide to order an MRI (magnetic resonance imaging) to get a closer look at the spine and surrounding structures to try to understand the underlying cause. However, when the MRI report comes back, it often contains medical jargon that can be confusing and even alarming. Terms like “degenerative,” “compression,” “deformity,” “height loss,” “advanced,” “severe,” and “narrowing” are scattered throughout the report. But what do these terms really mean, and how do they relate to your low back pain?
A Quick Anatomy Lesson
Before diving into the meanings of those intimidating terms, it’s helpful to understand some basics of spinal anatomy. The spine is divided into five regions: cervical (neck), thoracic, lumbar, sacral, and coccygeal. Humans have a total of 33 vertebrae, with each region having a unique number of vertebrae. These vertebrae are numbered from top (base of the skull) to bottom (tailbone). They are abbreviated with the first letter so C3 would be the 3rd cervical (neck) vertebrae from the top, T11 would be the 11th thoracic vertebrae, and L2 would be the second lumbar vertebrae. Each vertebra consists of various components, including the body, spinous process, transverse processes, lamina, foramen (spinal canal), superior and inferior facets, and the intervertebral disc.
Understanding the Discrepancy
First and foremost, it’s essential to recognize that MRI findings do not always correlate with clinical presentation. In fact, studies have shown that as many as 30% of individuals who are completely asymptomatic ( no low back pain or other related symptoms) can exhibit abnormal findings on a lumbar MRI (Kulkarni et al., 2020). This fact highlights a significant point: just because your MRI shows something, it doesn’t necessarily mean it’s the source of your pain. Instead, MRI results serve as valuable tools to assist your medical team, which may include physicians and physical therapists, in developing an individualized and comprehensive treatment plan.
Age-Related Changes
As we age, it becomes increasingly likely that the spine will undergo anatomical changes that can be visualized on an MRI but may not be the direct cause of pain or discomfort. For example, older adults may exhibit disc bulges or other structural alterations that do not necessarily lead to pain. In one study, 16 subjects over the age of 60 had multiple disc bulges but experienced no discomfort. This underscores the importance of considering age-related changes when interpreting MRI reports for low back pain in older adults.
Deciphering the MRI Report
Within an MRI report, there will typically be a title indicating the type of test and the body part examined. If a previous MRI has been performed and is accessible to the radiologist, there will often be a comparison discussion. The report then lists the findings, usually level by level.
Now, let’s demystify some of those intimidating terms:
1. Advanced Degenerative Changes: This term implies osteoarthritis of the joints in the spine. When “advanced” is used, it means that the cartilage between the bones is thinner, resulting in less space between the vertebrae.
2. Severe Narrowing:This indicates that a structure has become smaller or has less room to move. Another term for narrowing is “stenosis,” which can affect the spinal canal, leading to compression of the spinal cord or nerve roots.
3. Disc Bulge: A disc bulge refers to a portion of the cushion-like structure between the vertebrae protruding in a direction not aligned with the bones. It can bulge forward, backward, or to the sides.
4. Facet Hypertrophy: the bony protrusions connecting adjacent vertebrae have excessive growth, potentially causing them to impinge on other parts of the bone or the spinal canal.
5. Anterolisthesis: the upper vertebra is positioned more forward than the one below it.
Conclusion
Reading your MRI report and understanding the terminology can be empowering. However, it’s crucial not to become overly fixated on the number of abnormalities or the complexity of the findings. MRI serves as a tool to rule out serious conditions such as cancer or infection. Patients are encouraged to discuss their concerns and MRI results with their medical team, who can provide valuable insights and help guide appropriate treatment decisions. Remember, while the MRI report provides essential information, it is not the sole determinant of your condition, and your healthcare team is there to help you navigate the complexities of your low back pain and its potential causes.