While the MRI scan represents a very sensitive and accurate assessment of spinal anatomy, it cannot distinguish between painful and non-painful structures in the spine. In fact, a patient may have severe back pain and an MRI scan that shows a relatively normal-looking spine, or conversely may have no back pain but the MRI scan reveals a lot of anatomical problems. Thus, the findings on MRI scans do not constitute a diagnosis and the MRI findings must be correlated with the patient’s physical exam and symptoms of back pain to arrive at a clinical diagnosis.
It is not usually necessary to obtain an MRI scan at the initial onset of spine-related pain, as most cases of back pain and neck pain will resolve within two to twelve weeks with proper conservative (non-surgical) treatment. Quite often, MRI scans are needed when conservative treatment is not working and more aggressive treatments (e.g. injections or surgery) are contemplated to relieve back pain.
Spinal alignment
Disc height and hydration
Vertebral body configuration
Intervertebral disc - how does the disc appear? Is it normal, bulging, herniated, dehydrated or degenerated?
Spinal canal size - is it sufficient to comfortably accommodate the spinal cord and nerves? Is there spinal cord or nerve root compression?
Nerves - are the nerves “pinched” (compressed) or inflamed anywhere?
Abnormalities - are there any abnormalities near the spine that might simulate spinal pain?
Spinal cord - is the spinal cord normal in physical appearance?
If post-surgery - has anything changed since surgery? Is there another disc herniation, postoperative scarring or infection?
Often, based on the patient’s medical history
and physical exam, the treating physician will already
have an idea of what he or she is looking for on the
MRI scan results.
By:
Philip R. Shalen, MD
December 20, 2002
