Why Imaging Doesn’t Always Tell the Whole Story
In their paper published in the American Journal of Neuroradiology, Brinjikji et al. provide insight into the commonality of lumbar intervertebral disc herniation in asymptomatic individuals stratified by age. In their systematic literature review, the authors assessed 33 articles that reported imaging findings for 3110 asymptomatic individuals. [1]
Brinjiji reported that 29% of 20-year-old and 36% of 50-year-old asymptomatic patients have disc herniations on MRI. As we get older, the numbers increase. [1]
Nakashima et al. evaluated cervical spine MR images of 1211 healthy volunteers. They reported most subjects from ages 20-70 years of age presented with disc bulging (87.6%), which significantly increased with age in terms of frequency, severity, and number of levels. [2]
What does this all mean? Essentially, it highlights the importance of correlating a patient’s symptoms and clinical findings with imaging results like MRIs or X-rays. Doctors treat the patient, not the scan. While an MRI might show a disc herniation or bulge, that doesn’t automatically mean it’s the source of pain. The spine has many potential pain generators, including discs, facet joints, muscles, fascia, tendons, and ligaments. In some cases, your pain could be stemming from a different location entirely, even if the MRI shows an issue with a disc.
As always, if your symptoms are worsening or not improving, it’s important to follow up with your doctor. Red flags like loss of muscle strength, sensation, or function should never be ignored, as they require medical attention. In particular, loss of bowel or bladder control is a medical emergency and demands immediate care. Stay proactive about your health and seek help when necessary.
Suffering from back pain make an appointment with our clinic and see if chiropractic care can help you live a more pain free life.
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- Brinjikji et al. AJNR Am J Neuroradiol. 2005; 36:811–16.
- Nakashima et al. SPINE. 2015; 40(6):392-398.