Let’s talk about Back Pain and Imaging

It is common for an individual with lower back pain to be referred by their doctor or healthcare professional for imaging. MRI and CT imaging have been used more frequently as of late to assess individuals with lower back pain.¹

Usually, the results of the imaging return with several findings. This can be confusing and often scary to an individual who is already in some degree of pain or discomfort.

You may have received imaging results in your life, and heard the radiographer point out some of these findings: disc degeneration, disc bulge, annular fissure or facet degeneration.¹

Often, when these changes in the spine show up on imaging, a health professional may attribute it to the cause of the individual’s lower back pain.²

Unfortunately, imaging findings do not always correlate to pain. Many studies have shown that these degenerative changes of the spine are also present in individuals who are not experiencing any pain (asymptomatic individuals).^1-2

What imaging results have been found in asymptomatic individuals?

Image 1: Age-specific prevalence of disc degeneration in imaging of asymptomatic individuals

Image 2: Age-specific prevalence of disc bulges in imaging of asymptomatic individuals

Image 3: Age-specific prevalence of annular fissures in imaging of asymptomatic individuals

Image 4: Age-specific prevalence of facet degeneration in imaging of asymptomatic individuals

So what does this tell us about imaging results?

These studies lead us to consider that the findings on imaging results are a normal process of aging, and don’t always require intervention.¹

This is not to say that imaging of the lower back is redundant.² In many cases imaging is essential to rule out any serious pathologies that may be present.²

Imaging results should be considered as part of the larger picture of an individual’s pain presentation. Rather than thinking that these changes in the spine are the only reason the individual may be experiencing pain or altered function.

Dr Avanthi Wickramasekera (Osteopath)

B.Hsci., B.App.Sc. (Osteo)

References

Brinjikji W, Luetmer P, Comstock B, Bresnahan B, Chen L, Deyo R et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology. 2014;36(4):811-816.
Rao D, Scuderi G, Scuderi C, Grewal R, Sandhu S. The Use of Imaging in Management of Patients with Low Back Pain. Journal of Clinical Imaging Science. 2018;8:30.