Why Your MRI Scan Findings May Not Be the Cause of Your Back Pain

Many patients arrive in my clinic frightened by their MRI report. The wording sounds serious: disc degeneration, disc bulge, annular fissure, spondylolisthesis. Yet when I examine them, their symptoms are often manageable, or have already settled. The scan and the suffering do not always match.

Here I explain why so many findings on a spinal MRI look more alarming on paper than they feel in real life, and when those findings genuinely need attention.

Why do MRI reports sound so alarming?

An MRI is an extremely sensitive piece of diagnostic equipment. It produces highly detailed images of the spine, and it picks up small changes that may have no bearing on how you feel.

The most common findings are different grades of degenerative disc disease, or wear and tear, for want of a better term. This wear and tear shows up in the discs, the cushions between the bones of the spine, and sometimes in the facet joints that connect the arches at the back of the spine.

These changes are real. But they are not necessarily the source of your back pain.

What actually causes back pain?

Your spine is not a single structure. It is made up of bones, ligaments, joints, and the surrounding muscles, and any of these can contribute to pain. On top of that, there are behavioural factors that act as amplifiers, turning up the volume on the pain you feel.

So a finding on a scan is only one piece of a much larger picture.

What the research says about MRI findings in people with no pain

A study published in The Spine Journal looked at people across different age groups who had no back pain at all, and gave them an MRI scan.

The results were striking. The same phrases that worry patients on their reports turned up routinely in people with no symptoms: disc degeneration, signal loss, disc bulge, disc protrusion, annular fissure (a tear in the lining of the disc), facet degeneration, and even spondylolisthesis, where one bone slips forward over the one beneath it.

These findings are common in every age group, and they become more common as we get older, even in people with no pain whatsoever. A degenerate disc on a scan can be as normal a part of ageing as a grey hair.

When do MRI findings actually need treatment?

There are clear situations where a finding does prompt me to consider surgery.

The first is spinal cord compression. In the cervical spine, the neck, pressure on the spinal cord can cause weakness in the arms and legs, or a loss of function. Here the aim is to decompress the area, free up the spinal cord, and give it the best chance of recovery.

The second is nerve compression in the lower back. In the lumbar spine, the nerves can be compressed by stenosis or by an acute disc herniation. This is only something we would consider treating surgically if it is producing symptoms in the legs.

The pattern is consistent: it is the effect on your nerves and your function that matters, not the wording on the report.

What about spondylolisthesis?

Spondylolisthesis is another phrase that understandably worries people. It describes one bone slipping forward over the one beneath it, and it can look dramatic on a scan.

It is also a very common finding in people with no back pain at all. It only becomes relevant if it is compressing a nerve and causing leg pain. If that is the case, then yes, it may well be the source of your symptoms and worth treating.

The bottom line: we treat the patient, not the scan

If your back pain comes and goes, and it is manageable, it is worth remembering that many of these MRI findings should be considered normal.

We only treat them when we can prove they are the source of your pain, and when your pain has failed to respond to other measures. We will also act when there is nerve compression or spinal cord compression affecting the function of your arms and legs.

As I often tell my patients, our job is to treat the patient, not the scan. That is why a thorough history and a careful examination matter far more than the words printed on your MRI report.

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