Magnetic resonance imaging, more commonly known as MRI, can be a valuable and important tool but how reliable is it? MRI’s are utilized by many physicians in the diagnosis and management of musculoskeletal injuries. An important thing to keep in mind is that
imaging, whether MRI or X-ray, is not an indicator of pain or prognosis. I stress this point because I often see patients who rely heavily on the results of their MRI as the explanation to their pain. I will touch on lumbar disc pathology, aka low back pain, but these principles apply for all injuries and body parts.
Things to know:
- There are varying degrees of disc herniations
- The highest prevalence of lumbar disc hernations is among individuals age 30-50
- Males are 2x more likely to experience a disc bulge than females
- The medical cost for disc surgery can be between $20,000-$50,000- Thank goodness for insurance!
The accuracy of MRI imaging:
An article published in the Journal of Orthopaedic Surgery and Research found:
- MRI to be only 70% accurate in detecting the containment status of lumbar discs
- 28% percent of patients who showed a disc herniation on MRI did not actually have one when they were opened up for surgery
- 33% of patients with a negative MRI actually had a herniation
So what does this tell us?
MRI can in fact be inaccurate and further supports that imaging does not correlate with pain levels. As physical therapists we treat the individual, not the image/MRI. These statistics could also help to explain why 19-27% of individuals without symptoms have a disc herniation on imaging.
Healing of disc herniations:
Did you know that disc herniations can spontaneously heal themselves over time? A recent article found the incidence of spontaneous lumbar disc resorption to be 66.66% with conservative treatment. In the United Kingdom, this number is even higher at 82.94%. This is a great example of how resilient our bodies are and means that our discs can heal themselves over time.
Clinical implications: Do I need surgery?
Studies of acute lumbar disc herniations have found little difference between individuals who underwent surgery and those who did not at 2 and 5 year follow-ups. MRI is almost always indicated when determining the need and appropriateness for surgery. MRI inaccuracy in addition to similar post-surgical outcomes should warrant the use of conservative treatment. It is best to try conservative approaches first, and fortunately low back pain responds well to physical therapy. Low back pain is extremely common and often associated with other impairments in flexibility, core and hip strength, lumbar stability, and soft tissue dysfunction to name a few. Your physical therapist can help to address all of these in order to keep you healthy, pain-free, and off the operating table.
For more information on how we treat the spine, click here.
Interested in learning more? Chexk out our blog on the Top 4 Myths of back pain.