Why Does my Lower Back MRI Look so Bad?

Orthopaedic & Spine Center

Jeffrey R. Carlson, MD

Patients can be very concerned with the words “degenerative disc disease” or “spondylosis” when used in the report sent from a radiologist’s reading of an MRI.  These phrases and words are used synonymously with “arthritis”.  Our spinal discs wear with time, just like brake pads on a car.  This wear is seen on an MRI as a loss of the sponginess or hydration of the disc, so the radiologist will call this “degenerative arthritis”. 

 So, what does an MRI that shows arthritis mean for the patient in the long-term?  A recent study published in Spine (August 18, 2021) gives a good answer.  These researchers evaluated 3369 patients by performing an MRI, evaluated their back pain and followed their progress over six years.  They did find that the older patients had more evidence of arthritis on their MRI.  They also found that no matter the amount of arthritis seen on the MRI of the lower back, the patients did not see a worsening of their pain throughout the study.   This is welcome news to all of us with arthritis.  What they were able to conclude, is the MRI has little to do with the amount of back pain someone has or will have with time.

As my practice is focused on spinal and associated nerve disorders, I see patients in my office every day that have had an MRI that shows arthritis.  These patients comprise the entirety of our population; old, young, male, female and from all over the world.  Almost all are surprised to be informed that the MRI shows arthritis in their discs.  Degenerative disc disease is a long-term aging process.  We know, however, that a majority of patients over 40 will have arthritis in their lower back discs.   However, only about 50% of patients with arthritis will have pain.  Even fewer of these patients will need spine surgery.  Usually back pain is best treated with physical therapy, medications or injections. Only about 16% of patients that have back pain, will be referred to a spine surgeon and only about 2% of all back pain patients will have spinal surgery. 


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