Postive MRI for Herniated Disc

Many new patients come into our office with a diagnosis of “herniated disc.” When we perform a physical examination and take a medical history from the patient, often we confirm that the problem of back pain is NOT the herniatedisc! It is pain stemming from and radiating from a ligament, In other words, they have a sprain!
 
This is difficult for people to understand because they see the MRI, they have the interpretation from the orthopedic surgeon or the neurosurgeon. They come into our office with a film and/or image of a disc sticking out as much as 10 millimeters. How could this NOT be the source of back problems?
 
Unfortunately, many patients want to keep the diagnosis that the MRI, CT, and x-rays suggest of  “Degenerative Disc Disease.” 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.
 
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.

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