21/11/2025
Is Your Back Pain Really Matches Your MRI Results? What the Science Says
▪️ It is widely known that low back pain has a high prevalence in industrialized countries, affecting up to two-thirds of adults during their lifetime.
▪️ When back pain strikes, advanced imaging like MRI is often used to determine the cause.
▪️ However, the findings on these scans can be highly misleading.
▪️ A systematic review examining imaging features of spinal degeneration in 3110 asymptomatic (pain-free) individuals found that many commonly identified degenerative features are likely just part of the normal aging process and are unassociated with low back pain.
▪️ The Shocking Prevalence of Degeneration in Pain-Free Spines
▪️ MRI is highly sensitive in detecting degenerative changes.
▪️ The systematic literature review found that the prevalence of these changes increases significantly with age in people who have no back pain.
▪️ For example, look at how common these findings are, even among people who are completely asymptomatic:
▪️ Disk degeneration is common in younger adults and extremely common in older adults.
▪️ Disk bulge becomes increasingly prevalent with age.
▪️ Disk protrusion appears in a notable portion of both younger and older asymptomatic individuals.
▪️ Disk signal loss increases dramatically with advancing age.
▪️ Facet degeneration becomes more common with age.
▪️ The data shows that even in relatively young adults (30–39 years of age), half or more have disk degeneration, height loss, or bulging.
▪️ For individuals 60 years of age or older, findings like disk degeneration and signal loss are present in nearly all asymptomatic individuals.
▪️ The Risk of Misinterpretation
▪️ When advanced imaging is used to evaluate low back pain, features such as disk degeneration, disk protrusion, and facet hypertrophy are often interpreted as the causes of the pain.
▪️ This interpretation can trigger medical and surgical interventions that are sometimes unsuccessful in alleviating symptoms.
▪️ The systematic review concluded that many imaging-based degenerative features should be viewed as normal aging, not necessarily pathologic processes requiring intervention.
▪️ Prior research has also failed to find a consistent association between low back pain and many MRI findings.
▪️ In fact, one study found that a composite MRI score for degenerative changes did not correlate with the intensity of low back pain or disability in candidates for disk prosthesis.
▪️ The Crucial Takeaway
▪️ To avoid misleading diagnoses and unnecessary treatment, the sources emphasize the importance of context: Imaging findings must be interpreted in the context of the patient’s clinical condition.
▪️ Knowledge of the high prevalence of these findings in similarly aged asymptomatic individuals is crucial for both providers and patients when assessing the clinical significance of an MRI report.
▪️ If degenerative spine findings are seen incidentally—for example, a disk herniation at a level that doesn't correlate with physical examination findings—they should likely be considered normal age-related changes.
