Imaging (x-rays and MRI's) and back pain
Let's have a new conversation
If x-rays and MRI’s are “normal,” why is there pain? And, if you have an “abnormal” MRI result, what can that mean?
This week, we’re talking about MRI’s and X-rays…what are they? What are some positives and negatives? I will go over each of these questions so you have more information about them and can make an informed decision about your care when you see your medical provider.
First off, what are they?
MRI stands for magnetic resonance image and uses magnets to create a picture of the body part being scanned. It allows a radiologist to look at soft tissue structures, bony structures, organs and nerves in a specific part of the body. The radiologist interprets the results and then generates a report to go along with the actual images that compares your pictures to what is considered “normal.”
X-rays are created to primarily examine the skeleton. X-rays can pick up density of tissue and can also detect masses or tumors. They can also detect a foreign body inside your body.
What are some positives about these diagnostic tests? Negatives?
One positive is that you can get a clearer picture about what is going on inside your body. You can see broken bones, tumors, pinched nerves, changes in the joints, muscle tears, and inflammation.
One negative is that they are not 100% accurate meaning that there can be a false-positive or a false-negative test result. What I mean by that is that with a false-positive result, an MRI may come back with an abnormal result, but the disease or problem may not actually be present. With a false-negative result, the MRI may come back normal and there is a disease or problem actually present.
1In a study by R Herzog, there is wide variability in MRI interpretations based where the MRI is performed and which radiologist interprets the images. So, who reads your MRI can influence the interpretation of the images.
2In another study, 40% of people under the age of 30 had lumbar (lower back) degenerative changes in their discs and this percentage increases to over 90% by ages 50-55.
But, this doesn’t always mean that pain is present. In a third study where none of the participants had lower back pain, only 36% of participants had normal appearances of the lumbar discs.3
And, lastly, 4according to Hall, less than 5-10% of people experiencing lower back pain that is due to specific spine pathology. As we age, our bodies change. Not all of these changes are the primary cause of lower back pain. There are people with changes on their MRI scans and x-rays who never have lower back pain. For example, people aged 50, 80% have disc degeneration and 60% have a bulging disc. By age 60, 88% have disc degeneration and 69% have a bulging disc. And, these percentages of people who have this are also people without back pain. Yes, without back pain.
In my opinion, research has shown that there are normal changes on X-rays and MRI’s that are related to aging. These changes may or may not be the source of your pain. You are more than an image, you are more than your MRI. Listen to your own wisdom and use the information to help guide you on your path toward restoring balance within your system. Please do not ignore the signs your body is telling you and seek medical advice/treatment as necessary. Diagnostic imaging such as MRI’s and x-rays can help in you understand what is going on with your lower back, but they are not the final word on why you may feel the way you do. They also do not determine your fate. Just because you may have a diagnosis of a bulging disc or degenerative disc changes, the diagnosis does not determine that you are on your way to the operating room or that you are disabled. They can be valuable information to have on your quest toward healing, but they do not determine your final outcome.
Herzog R, Elgort DR, Flanders AE, Moley PJ. Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period. Spine J. 2017 Apr;17(4):554-561. doi: 10.1016/j.spinee.2016.11.009. Epub 2016 Nov 17. PMID: 27867079
Cheung, Kenneth M. C. MBBS, MD, FRCS, FHKCOS, FHKAM*; Karppinen, Jaro MD, PhD†; Chan, Danny PhD‡; Ho, Daniel W. H.‡; Song, You-Qiang PhD‡; Sham, Pak MD, PhD§; Cheah, Kathryn S. E. PhD‡; Leong, John C. Y. OBE, FRCS, FRCSE, FRACS, FHKAM, JP*¶; Luk, Keith D. K. MCh, FRCSE, FRCSG, FRACS, FHKAM*. Prevalence and Pattern of Lumbar Magnetic Resonance Imaging Changes in a Population Study of One Thousand Forty-Three Individuals. Spine 34(9):p 934-940, April 20, 2009. | DOI: 10.1097/BRS.0b013e3181a01b3f
Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994 Jul 14;331(2):69-73. doi: 10.1056/NEJM199407143310201. PMID: 8208267
Hall AM, Aubrey-Bassler K, Thorne B, Maher CG. Do not routinely offer imaging for uncomplicated low back pain. BMJ. 2021 Feb 12;372:n291. doi: 10.1136/bmj.n291. PMID: 33579691; PMCID: PMC8023332.