For many individuals, their radiology (x-ray and/or MRI) reports often include a variety of intimidating terms such as “degeneration,” “degenerative disc disease,” “spondylosis,” “disc bulges,” “osteophytes,” “stenosis,” etc. These terms can be scary when associated with your bones, joints or spine. What is not typically found in these reports however is that these terms and findings tend to be part of the natural aging process and often times are completely normal and do not require intervention. A large percentage of the time the symptoms and pain individuals are experiencing do not correlate with their images and are actually incidental findings.
When looking at disc degeneration specifically, the “Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations” showed that by age 20, 37% of asymptomatic individuals (i.e. having no symptoms) demonstrated some level of disc degeneration and that by age 80, in the asymptomatic population, 96% of individuals demonstrated disc degeneration. This shows that degenerative changes can sometimes be found on imaging as early as age 20 in individuals without symptoms such as pain, which suggests such changes are simply part of the normal aging process.
The following is a table from Brinjikji et al demonstrating the prevalence of degenerative changes in the spine found in asymptotic individuals:
Often times when patients are experiencing radicular symptoms (pain, numbness, or tingling which travels from the spine down the arms or legs) they fear their symptoms are related to an abnormality in the intervertebral discs, which lie in between each vertebra and are like the shock absorbers of the spine. This often leads individuals to believe that they need imaging, either MRI or x-ray, in order to find out what is wrong and the best way to treat it. This is not always the case.
In an article written by Modic et al. titled “Acute Low Back Pain and Radiculopathy: MR Imaging Findings and Their Prognostic Role and Effect on Outcome,” it was concluded that “in typical patients with low back pain or radiculopathy, MR imaging does not appear to have measurable value in terms of planning conservative care. Patient knowledge of imaging findings does not alter outcome and is associated with a lesser sense of well-being.”
In the study, the imaging did not provide any additional information that would change the treatment the patients received, nor did it alter the outcomes of treatment. However, the imaging did negatively impact the patients’ sense of well-being, meaning the imaging had more influence over the patients’ mental state than it did over the recommended course of treatment.
Pictures can say 1,000 words. Often when the picture is an image of our musculoskeletal system (bones, joints, and soft tissues) we experience a strong emotional reaction, and those 1,000 words can influence our outlook. For many musculoskeletal complaints, an initial trail of conservative care (e.g. chiropractic or physical therapy), without the need for imaging, is appropriate. That being said, there are many cases where images are warranted, such as when red flags are found during the history and examination which would raise concern about a potentially serious condition or pathology. Patients should consult a health care professional regarding their pain and ask questions regarding their image findings, but don’t be too worried by some potentially incidental degeneration—it’s the grey hairs of your spine.
W. Brinjikji, P.H. Luetmer, B. Comstock, B.W. Bresnahan, L.E. Chen, R.A. Deyo, S. Halabi, J.A. Turner, A.L. Avins, K. James, J.T. Wald, D.F. Kallmes and J.G. Jarvik, “Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations.” American Journal of Neuroradiology . Apr 2015.
Michael T. Modic, Nancy A. Obuchowski, Jeffrey S. Ross, Michael N. Brant-Zawadzki, Paul N. Grooff, Daniel J. Mazanec, Edward C. Benzel, “Acute Low Back Pain and Radiculopathy: MR Imaging Findings and Their Prognostic Role and Effect on a.” The Radiological Society of North America . Nov 1, 2005.