You’ve had an x-ray or MRI. Now what?

Many doctors are reporting that MRIs and x-rays are overused for low back pain. Why are they saying this?

Unless something serious like a spine infection or what we call progressive neurologic deficits are happening, imaging shouldn’t be done in the first 6 weeks. Progressive neurologic deficits are progressive weakening of specific muscles or progressive sensation loss somewhere in the legs.

Some say that they need an image so they know what is going on in their back. The problem is imaging doesn’t help you improve and it can add thousands of dollars in unneccessary medical costs for you.

Here is what people with pain often have on their imaging.

  • Modic type I and type III changes
  • Disc extrusion and sequestration
  • Multiple levels of disc degeneration

People with pain can obviously have other findings, but those findings are often in people without pain too! This chart shows the percentage of people in each age group that have other findings, but no pain.

We normally call these findings “wrinkles on the inside”. We do notice that if we have wrinkles earlier in life then they normally cause more pain than later in life. Basically if we have wrinkles on the outside then the wrinkles on the inside are as harmless as the wrinkles on the inside.

Even if you have wrinkles on the inside and you are younger or you have modic changes, disc extrusion and sequestration, or multiple levels of disc degeneration that doesn’t mean you’re doomed to pain. Thus, control what you can. Get good sleep, exercise, eat well, and make sure to take time to meditate or perform specific relaxation practice. Plus, it is not uncommon for back pain to improve as people age.

Rahyussalim, Ahmad Jabir, Muhammad Luqman Labib Zufar, and Tri Kurniawati. “Significance of the association between disc degeneration changes on imaging and low back pain: a review article.” Asian spine journal 14.2 (2020): 245.

Brinjikji, W., et al. “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.” American Journal of Neuroradiology 36.4 (2015): 811-816.

Brinjikji W, Diehn FE, Jarvik JG, Carr CM, Kallmes DF, Murad MH, et al. MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic

Controls: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol. 2015;36: 2394–2399.