The MRI is an outstanding diagnostic tool that has greatly advanced the field of Spine Surgery. However, Brinjikji et al. report that not all MRI findings are the source of symptoms, but instead, are seen in a majority of asymptomatic individuals.
MRI - A Source Of Hope Or Fear?
Your back pain, leg pain, or other concern led you to take the plunge and get a MRI of your low back. The MRI may represent a long-fought battle with these symptoms, or perhaps, a separate battle with physicians and insurance companies who recommended against a MRI.
You receive the Radiologist's report. On one hand, you do not want there to be any findings on your MRI (obviously). But on the other hand, a small part of you actually wants there to be something on your MRI to not only explain your symptoms, but also validate the suffering you have endured with these symptoms.
A finding on the MRI provides you some hope -- a hope for a solution and relief. So you rip open the envelope. Even though your name is at the top, it is difficult to believe the report is about you. The words describe your anatomy, but it feels so detached and impersonal. Still, you hang on to every word, trying to make sense of some of the words you have never seen before. You understand enough about the report and it...is...TERRIFYING.
"SEVERE stenosis"
"Disc BULGE effacing the nerve root"
"Multiple areas of advanced disc DEGENERATION"
"Degenerative spondylolisthesis with resultant COMPRESSION of the thecal sac"
You put the report down, unsure what to make of everything and what your next step should be.
The Radiologist As A Horror Author
I always joke that Radiologists should go into Horror. They love the dark. They know your inner workings (on CT / MRI, sorry -- bad joke). And they are great at writing scary radiology reports.
All jokes aside, I have the utmost respect for my Radiology colleagues. I depend on them every day, and a couple of my really close friends are amazing Radiologists. But that does little to help you. What do you do with these MRI findings?
I have some good news for you. MRI is an incredible diagnostic tool and has greatly advanced the field of Spine Surgery. It allows incredible visualization of spinal pathology and is highly sensitive in detecting abnormalities. These are good things, yay!
However, the MRI machine does not know your symptoms. And while the Radiologist interpreting your study may know some cursory details about your symptoms, he/she does not have the benefit of knowing you, your exact symptoms, and your physical exam findings.
As such, while the MRI is incredibly sensitive in detecting abnormalities, it is not very specific. For example, you may have a disc bulge or disc degeneration on your MRI, but that does not mean it is causing you any symptoms.
Brinjikji et al. investigated the prevalence of MRI findings in asymptomatic individuals in a study published in the American Journal of Neuroradiology. They argued that it is "important to know the prevalence of (lumbar spine MRI) findings in asymptomatic individuals" in order to better interpret the true significance of these findings.
This study found that there is an age-related prevalence of degenerative spine findings on MRI. This is not that surprising, as an older individual has presumably experienced more "wear and tear" on his/her low back. However, a vast majority of these degenerative changes are found in individuals without symptoms (see full chart here).
In other words, the fact that your MRI report reveals "degenerative disc disease" and "disc bulges" should not alarm you. Most individuals have these degenerative changes and have no idea. If you are one of the "fortunate" few to have a MRI, you more than likely received a Radiologist's confirmation that you are like most other individuals in this world.
But What About MY Symptoms?
While the above-mentioned study should make you feel (slightly) better about your MRI report. However, I am sure that it did little to ease the symptoms that motivated you to get the MRI in the first place.
Of course, there are findings on the MRI that are linked to your symptoms. Otherwise, there would be no need for Spine Surgeons. But if asymptomatic individuals have changes on their MRI, how do we even begin to interpret MRI results?
Well my friend, we forgot to factor in the most important person...YOU!
A Wise Person Once Told Me...
Treat the patient, NOT the MRI
The MRI does not replace you. The MRI does not replace the physician and physical exam. These will always be at the core of medicine and are what help to interpret the MRI results beyond scary adjectives, verbs, and nouns.
My mentors placed high value on being able to detect a patient's issues through an interview and exam. Throughout my training, if a patient already came with a MRI, I was not allowed to view the MRI until after I had seen the patient. What did I think the patient had? Once I answered that question, we then viewed the MRI and formulated a plan. To this day, I still utilize this approach.
The MRI is like a luxury item -- not necessary but definitely appreciated. The MRI should be used to improve the accuracy of diagnosis, treatment, and subsequent outcomes. It is not something to rely on.
It is my job to evaluate your symptoms, interpret your MRI, determine if your symptoms are concordant with the MRI findings, and develop the best treatment plan for you.
What Should You Do With Your MRI
If you are going to read your MRI report, consult reputable resources (like this website, shameless plug) to educate yourself
Beware of "Dr. Google." Some other websites to consider:
Have a complete evaluation by a Spine Specialist
If he/she does not spend the time to review your MRI and its relevance to your symptoms, I suggest that you obtain a second-opinion
Always remember that your symptoms, not the MRI, should dictate your treatment