How to understand your spine MRI report

You have your MRI result and it is full of words you do not know: “bulging”, “protrusion”, “stenosis”, “degeneration”. Some people get worried just from reading them. This article helps you see what the report says and what it does not say.

It matters to know that this article does not replace a doctor going through your result. It is only a general guide.

What does an MRI show?

MRI is the most common scan for a disc, and it shows the spinal cord, the nerve roots and the tissue around them. A plain X-ray cannot show a disc herniation and is used mostly to see a fracture, a tumour or an infection. A CT scan shows the size and shape of the canal and the bone well. Sometimes a nerve conduction study is also needed to see nerve damage.

What do the words mean?

These meanings are simple and general. Your report may use other words.

• Spine / vertebra / disc. The vertebrae are bones stacked on each other, and between every two is a soft disc that works like a cushion. A disc has a tougher outer wall and a softer centre.
• Spinal canal. The space behind the vertebrae through which the spinal cord and nerves pass.
• Nerve root. The nerves that leave the spinal cord on both sides and go to the arms and legs. When squeezed, they may cause pain, numbness or weakness.
• Disc herniation. When part of the soft centre of the disc pushes out through the wall. The words bulge, slip and rupture are also used for the same thing. Reports may also use words such as protrusion or extrusion; the radiologist or surgeon explains the exact difference. Whether it presses on a nerve matters more than its name.
• Bulge. The disc has moved slightly out from its usual place. Many people have a bulging disc and do not know it.
• Degeneration / disc wear. With age, discs get shorter and lose their spongy quality. This is often part of ageing.
• Osteophyte. A bony spur that slowly grows on the vertebrae and can narrow the canal.
• Stenosis (narrowing of the canal). The spinal canal, or the place where a nerve leaves it, has become narrow. This narrowing does not always cause symptoms. Symptoms come from inflammation or pressure on the nerve.
• Spondylolisthesis (slipped vertebra). One vertebra slips over the one below; the most common place is the fourth lumbar vertebra over the fifth.
• Thickened ligament. Ligaments thicken with age and contribute to narrowing of the canal.

A report is a picture, not a complete diagnosis

Two people with the same report may have very different symptoms. Common examples:

• Many people have a bulging disc and no symptoms at all.
• A narrow canal does not always cause symptoms.
• A disc herniation that does not press on a nerve may cause only back pain, or even no pain.

This is why the surgeon reads the report alongside your symptoms and a neurological examination (strength, feeling, reflexes, walking). If the place where the image shows pressure matches the place of your pain or numbness, that matters for the treatment decision. If it does not match, the finding on the image is not necessarily the main cause of your pain.

Does my report mean surgery?

Not by itself. Most disc problems get better without surgery and treatment starts with staying active, medicine, physiotherapy and sometimes an injection. The reasons for surgery are mostly these: nerve pain that has limited life, weakness or numbness that is getting worse, bladder or bowel problems, and treatment without surgery not working. Details are in the article “Does back pain always need surgery?”.

What should you tell a doctor at once?

Even if the report looks simple, these symptoms are urgent: numbness around the anus or genitals, trouble with the bladder or bowel, weakness or numbness in both legs, or severe or worsening weakness in a leg or arm. In that case call 115 or go to an emergency department (115 is Iran’s emergency number).

What to do with the report and the images

• Take both the report and the images themselves (film or disc) to your visit. The report is the radiologist’s summary, and the surgeon looks at the images too.
• Bring older images as well, so they can be compared.
• Do not draw conclusions from the report based on an internet search. What each phrase means depends on the person and their symptoms.

Questions to ask the surgeon

• Which findings on this image relate to my symptoms? Which are probably unimportant?
• Is a nerve under pressure? At which level?
• What treatment do you think suits me for now, and how long should we wait?
• When should the scan be repeated?
• Which sign should make me come back sooner?