Most people these days have heard of an MRI scan or even had one done. They can be a useful tool for physicians to pick up an array of conditions and diseases.
One of the things you can get a scan for is of your back. This is what many people ask for relatively early on if not straight away when they get any sort of back pain.
Now a scan is very good at picking up abnormalities in the spine from bulges, protrusions and extrusions.
Now patient x has had lower back pain for a while and finally thinks they should go and have an MRI scan to see whats going on.
So patient x goes for a scan on their back and it turns out they have a bulging disc!
Patient x then has the operation to fix it…. Shock horror!!, their back pain pain is still there! How could this be you ask? The MRI scan showed a bulging disk which was obviously causing patient x’s pain. They then went and had the operation to fix it!
What happened with our hypothetical subject?
Well studies on MRI scans of the back have been going on since the 80’s. It was in the early 90’s a famous study by Maureen C. Jensen, Michael N. Brant-Zawadzki, Nancy Obuchowski, Michael T. Modic, Dennis Malkasian, and Jeffrey S. Ross.
They looked at 98 asymptomatic people (Completely healthy) and got them all to have an MRI scan of their lower back
A massive 52% had a bulge at one level, 27% had a protusion and 38% had an abnormality at more than one level. The authors concluded that protrusions or bulges in people with lower back pain may frequently be coincidental.
Another study, this time of the cervical spine ( top third of your spine) in 2012. A Massive 1211 people were recruited from their 20’s right through to their 70’s, both males and females. The authors came to the same conclusion as 1994 that there is a relatively high prevalence of abnormal MRI findings in symptom free people.
A complete review of spinal degeneration in symptom free populations took place earlier this year and reached the same conclusion that image-based degenerative features are very likely down to aging and are in face unassociated with pain.
It is potentially massive the number of people over the years have gone on and had operations needlessly off the back of having MRI scans.
It can even add an awful amount of stress as it causes unnessassery worry all because people aren’t told that these changes/abnormal findings are a perfectly natural sign of aging much like getting grey hairs and wrinkles.
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., … & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.
http://www.ncbi.nlm.nih.gov/pubmed/25430861
Jensen, M. C., Brant-Zawadzki, M. N., Obuchowski, N., Modic, M. T., Malkasian, D., & Ross, J. S. (1994). Magnetic resonance imaging of the lumbar spine in people without back pain. New England Journal of Medicine, 331(2), 69-73.
http://www.nejm.org/doi/full/10.1056/NEJM199407143310201#Top
Kato, F., Yukawa, Y., Suda, K., Yamagata, M., & Ueta, T. (2012). Normal morphology, age-related changes and abnormal findings of the cervical spine. Part II: Magnetic resonance imaging of over 1,200 asymptomatic subjects. European Spine Journal, 21(8), 1499-1507.
http://link.springer.com/article/10.1007/s00586-012-2176-4#/page-1
British Journal of Sports Medicine