You opened the patient portal before your doctor called.
Maybe it was a Sunday. Maybe it was nine at night.
If you have ever read your own MRI report and felt your stomach drop — this article is for you.
Read the Full Video Transcript
DISCLAIMER:
Transcript lightly edited for clarity and readability. The views expressed are intended to explore the full range of clinical considerations in spine care and do not constitute medical advice. Outcomes vary by patient and pain pattern. For guidance specific to your situation, consult a spine specialist.
TRANSCRIPT TEXT:
An MRI report is not a diagnosis. It is one radiologist’s written interpretation of a set of images. And for many patients, it can sound far more alarming than the actual clinical picture warrants.
Welcome to this Vertrae® 360 explainer. Today, we are going to untangle one of the most stressful, heart-dropping experiences in modern healthcare.
You may know the exact moment: your phone buzzes with a notification from your health app. Your MRI results are ready. Your doctor has not called yet, but the portal is right there, almost begging to be clicked. So you click it, and suddenly you are staring at clinical terms that make it feel like your spine is crumbling.
If you have ever read your own MRI report alone in your living room and felt your anxiety spike, this explainer was made for you.
Let’s pause and let this foundational truth sink in: the report you are reading is a highly technical description drafted by someone who may not have met you, watched you walk, examined your spine, or heard your story. Yet somehow, that report can shape how you feel about your body.
Many patients today read their MRI reports before their doctor has a chance to call. We sometimes call this “patient portal panic.” And it usually happens at the worst possible time. Maybe it is a Sunday. Maybe it is 9 o’clock at night. You are sitting there alone, reading words like “multilevel fissure,” “disc desiccation,” or “stenosis,” and suddenly a backache that felt like ordinary morning soreness feels like a catastrophic injury.
Your mind starts to spiral. You start searching the internet. But what you are experiencing in that moment may not be a medical crisis. It may be a communication gap.
We can take some of the fear out of these terms by acting as a medical interpreter for a moment. These phrases sound serious because they are technical, not necessarily because they are dangerous.
Take disc desiccation. It sounds alarming, but it simply means the disc has lost some water content over time. This is very common with aging and often does not cause pain.
Or take annular fissure. That refers to a small split in the outer ring of a disc. Thecal sac indentation sounds dramatic, but it means something is mildly pressing on or touching the covering around the nerves. Even central canal stenosis sounds catastrophic, but it simply describes narrowing of the spinal canal. Depending on the degree of narrowing and the patient’s symptoms, it may or may not be causing problems.
The vocabulary is dense, but the reality is often more routine than the report makes it sound.
This brings us to the next core point: imaging findings that are labeled “abnormal” are remarkably common in people who feel completely fine.
According to a major 2015 systematic review, findings such as disc degeneration, disc bulges, and signal loss become increasingly common with each decade of life. In older age groups, many people walking around with no pain at all have these so-called abnormalities on their scans.
A 2022 population-based study of more than 3,000 participants supported this point, finding that many individual degenerative findings on MRI had only a weak association with actual pain.
Aging shows up on an MRI the same way wrinkles show up on human skin. It is evidence of life, not automatically a source of pain or a fast track to surgery.
Now, let’s talk about a number that might change how you view medical imaging: 49.
That number comes from one of the most surprising findings in recent medical literature. In a 2017 study published in The Spine Journal, researchers sent one patient — one person with the exact same spine — to 10 different MRI centers over the course of three weeks.
Each center produced its own radiology report. Across those 10 reports, radiologists described 49 distinct findings. But here is the key point: zero findings appeared in all 10 reports. Not a single one.
Only about one-third of the findings appeared in more than one report.
This does not mean the radiologists were bad at their jobs. It shows that the lumbar spine is complex, and interpreting these images can involve judgment. A small difference in how a radiologist words a report can dramatically change how frightening it sounds to a patient.
So if you have ever wondered whether getting a second opinion is reasonable, the answer is yes. In many cases, it can be a thoughtful and appropriate step.
The words themselves matter. Research has shown that the way a report is written can influence how patients think, feel, and recover.
When patients receive a routine, heavily medicalized radiology report, they may develop more negative beliefs about their spine and more anxiety about their condition. But when the same medical information is explained in context — for example, as common age-related change — patients may feel less fear and more confidence.
Reading terms like “degeneration,” “tear,” or “collapse” in an online portal can increase anxiety, especially when the patient has not yet had a clinician explain what those terms actually mean. The words can make the pain feel scarier.
But let’s flip the scenario. What if your MRI comes back completely normal or “unremarkable,” but you are in severe, life-changing daily pain?
That can feel incredibly invalidating, as if the imaging is calling your experience into question.
A landmark 2018 paper in The Lancet addressed this directly by discussing the concept of nonspecific low back pain. This does not mean the pain is imaginary. It means the pain may involve muscles, joints, nerves, inflammation, movement patterns, or nervous system sensitivity that does not always show up clearly on a black-and-white structural image.
A clean-looking MRI does not mean nothing is wrong, just as an alarming-looking MRI does not always mean something serious is wrong.
The report is one piece of a much bigger picture.
So how do we figure out what is actually wrong? By building a clinical diagnosis.
An MRI report is step one, not the entire answer. Think of it like a large puzzle. To reach a true diagnosis, the imaging has to be combined with symptoms, the physical exam, treatment history, and how the pain behaves in real life.
Does it hurt when you bend? When you walk? When you sit? Does it improve with leaning forward? Does it wake you up at night? Did an injection help? Did physical therapy change anything?
Any single piece by itself is incomplete. The most useful interpretation connects all of these pieces together.
Now, we need to be very clear: safety always comes first. There are situations in which MRI findings and symptoms warrant urgent medical attention.
If imaging findings match red-flag symptoms, you need a focused medical evaluation promptly. These symptoms may include progressive weakness in a leg or foot, numbness that follows a clear nerve pattern, worsening ability to walk, severe radiating leg pain that is getting worse, or any sudden change in bowel or bladder control.
In these cases, imaging is powerful because the images and the symptoms tell the same story.
But when the report and symptoms do not clearly align — or when you are stuck in patient portal panic — you need an approach that considers the whole person.
That brings us to the Vertrae® approach.
At Vertrae® in Miamisburg, Ohio, Dr. Kamal Woods, a dual fellowship-trained neurosurgeon and spine surgeon, does something essential. He does not just read the radiologist’s interpretation. He reviews the actual images directly, alongside your symptoms, physical exam, treatment history, and goals.
The goal at Vertrae® is not to blindly chase every finding listed on a report. The goal is to identify which specific finding, if any, is actually driving the pain you are feeling.
This is the through line of Vertrae®’s motion-first spine care philosophy, and it is summed up in one important idea:
The MRI shows anatomy. Your story shows whether that anatomy matters.
This places the patient at the center of the decision-making process, rather than letting a frightening report dictate the future. A finding labeled “moderate” may be unrelated to the pain, while something labeled “mild” may actually fit the symptom pattern. Only the full clinical picture can help reveal the difference.
As we wrap up this explainer, I want to leave you with one empowering thought.
The next time you are looking at a medical report that confuses or frightens you, the most useful question to ask your doctor may not be, “Is this report wrong?”
The more powerful question is:
Does the picture actually match the pain?
Keep that question in your back pocket. Let it guide your conversations, calm your anxiety, and help you seek the focused, comprehensive care you deserve.
Quick Answer
A lumbar MRI report can show disc changes, arthritis, stenosis, or nerve compression — but those findings do not always match where the pain is coming from. Some people have alarming-looking MRIs and feel fine. Others have severe pain and an unremarkable MRI. The most important step is matching the imaging to your symptoms, exam, and life. The report is one piece of the picture, not the whole one.
The Worst-Looking MRI in the Room Isn’t Always the Most Painful, and Here’s Why
The notification said your imaging report was ready, and you tapped it the way most people would. You started reading.
“Multi-level disc desiccation.”
“Annular fissure at L4-L5.”
“Mild central canal stenosis.”
“Disc material indenting the thecal sac.”
Your back, which had been merely sore that morning, suddenly felt like it was holding something terrible. By the time your doctor called the next day, you had read the report eleven times and visited three different websites.
That experience is not in your head. It is one of the most common moments in spine care — and it is also one of the most studied gaps in modern medicine.
Here is the part most patients are not told clearly enough.
An MRI report is not a diagnosis. It is one radiologist’s written interpretation of the images. |
The MRI report is one piece of a much bigger picture
It helps to be clear about what an MRI report actually is.
The MRI itself is an imaging scan of your spine. The report is a written interpretation of those pictures, prepared by a radiologist who is reading the images in a queue, often without meeting the patient and often without access to the full clinical story.
That makes the report useful. It does not make the report a diagnosis.
A diagnosis comes from putting several factors together: imaging, the patient’s symptoms, the physical exam, the treatment history, and how the pain behaves in real life. Any one of those, on its own, is incomplete. Sometimes the imaging tells the loudest story. Sometimes the symptoms do. The most useful interpretation connects them.
Snippet — What an MRI report actually is
An MRI report is a radiologist’s written interpretation of imaging, not a diagnosis. A diagnosis comes from integrating imaging with the patient’s symptoms, physical exam, treatment history, and how the pain actually behaves. The report is one piece. The patient’s story is what tells us whether the picture matches the pain.
The same spine can be described in different ways
This is one of the more surprising findings in the medical literature — and one of the most important for any patient holding a lumbar MRI report.
In a study published in The Spine Journal in 2017, researchers had a single patient — the same person, the same spine — undergo lumbar MRI examinations at ten different MRI centers within a three-week period (Herzog et al., 2017). Each center generated its own radiology report. The researchers then compared the reports with one another and against a reference standard read by subspecialist spine radiologists.
The results were striking. Across the ten reports, there were 49 distinct findings. Not a single finding appeared in all ten reports. Only one finding appeared in nine of ten. Roughly a third of the findings appeared in only one of the ten reports. Overall agreement between reports, measured statistically, was poor.
That does not mean radiologists are careless or that MRI reports should be ignored. It means lumbar spine imaging is genuinely difficult to interpret, and small differences in wording, emphasis, and interpretation can change how a report sounds to a patient. The lumbar spine has many small structures. There is real subjectivity in how to label what you see. Different radiologists, working from the same images, may legitimately describe the same finding in different ways — or notice different findings entirely.
If you have ever wondered whether a second opinion on an MRI report is reasonable, the answer is yes. It is not paranoia. It is in alignment with what the literature has shown.
Snippet — The same MRI can be read different ways
A 2017 study had one patient undergo a lumbar MRI at ten different centers within three weeks. The reports produced forty-nine distinct findings, with no single finding appearing in all ten reports. Lumbar MRI interpretation is genuinely complex. A second opinion is reasonable.
Scary-sounding findings are often common findings
This is the second important thing to understand about lumbar MRI reports.
Many of the most alarming-sounding terms in a typical lumbar MRI report describe changes that are common with age and frequently present in people with no back pain at all. A 2015 systematic review summarized imaging findings across populations of people who were completely asymptomatic — no back pain, no leg pain, no symptoms (Brinjikji et al., 2015). Disc degeneration, disc signal loss, disc bulges, and similar findings became increasingly common with each decade of life. By older age groups, several of these findings were present in the majority of people who felt completely fine.
A 2022 population-based cohort study in Spine took this further. Researchers followed more than 3,000 participants over 6 years, examining whether common lumbar MRI findings predicted who would develop or worsen low back pain (Kasch et al., 2022). The result: most individual MRI degenerative findings were not clinically important predictors of back pain. Almost all effects were less than one point on a zero-to-ten pain scale. About three-quarters of the participants had at least one MRI finding. Pain status, present and future, was only weakly tied to most of those findings.
Aging shows up on MRI the same way wrinkles show up on skin. That does not mean every finding is dangerous, painful, or in need of surgery.
This is also why a finding labeled “moderate” or even “severe” on a report is not automatically the source of pain. The MRI describes anatomy. Whether that anatomy matters in this patient — in this specific person, with these specific symptoms, on this specific exam — is a separate question.
Aging shows up on MRI the same way wrinkles show up on skin. That does not mean every finding is dangerous, painful, or in need of surgery. |
When MRI findings matter more urgently
It is also important to clearly state the other side of this.
MRI findings warrant closer, more immediate attention when they align with specific symptoms. Progressive weakness in a leg or foot. Numbness in a clear nerve pattern. A loss of walking tolerance over time. Severe leg pain that is not responding to time and conservative care. Any change in bowel or bladder control. Signs of meaningful nerve compression on physical exam.
In those situations, imaging becomes powerful because the picture and the symptoms are telling the same story. The goal of this article is not to ignore MRI findings or to suggest that imaging does not matter. The goal is to understand which findings matter — in this patient, with these symptoms, on this exam — and which findings are part of the background noise of a normally aging spine.
If any of the symptoms above describe your situation, the right next step is a focused spine evaluation, not reassurance from a blog post.
Snippet — When MRI findings matter more urgently
MRI findings warrant closer attention when they match symptoms such as progressive weakness, numbness in a clear nerve pattern, loss of walking tolerance, severe or worsening leg pain, or any change in bowel or bladder control. In those situations, imaging is powerful because the picture and the symptoms tell the same story.
A mild or unremarkable MRI does not mean the pain is not real
The mirror image is also true and just as important.
Some patients have severe, life-changing back pain when their MRI report comes back with words like “mild,” “unremarkable,” or “no significant findings.” That gap between report and experience is one of the most disorienting things a patient can encounter. It can feel like the imaging is calling you a liar.
It is not.
Most low back pain does not have a single, neat structural cause that lights up clearly on a scan. A landmark 2018 paper in The Lancet, summarizing the global state of low back pain research, made the point directly: most low back pain is described as “non-specific,” meaning that no specific anatomical source is identified (Hartvigsen et al., 2018). That does not mean the pain is fictional. It means the pain involves more than one structure, or that the relevant changes do not show up cleanly on imaging, or that the pain pattern reflects how the spine is moving rather than what it looks like in a still picture.
Pain involves muscles. It involves joints. It involves the small stabilizing muscles that may have lost their normal coordination. It involves nerves and inflammation. It involves the way the body has adapted around it. None of that is captured by a single still image of bone, disc, and nerve.
So, when an MRI report says “normal,” and your back still hurts every day, the most useful sentence is not “there is nothing wrong.” The most useful sentence is “let’s look at what the imaging may not be telling us.”
Why the wording of an MRI report can make pain feel worse
There is a smaller but striking body of research that examines what happens when patients read their own MRI reports.
In a randomized trial published in the European Spine Journal in 2021, researchers tested two different ways of communicating MRI findings to patients with low back pain (Rajasekaran et al., 2021). One group received a routine, factual radiology report. The other group received the same information framed in terms of normal age-related change. At six weeks of follow-up, the group given the routine-style report had more negative beliefs about their spine, less pain improvement, and poorer function than the group given the contextualized version.
In other words, the wording of the report itself, separate from the underlying imaging, affected how patients did.
A 2023 study in the Journal of Pain Research surveyed 162 patients who had read their own thoraco-lumbar MRI or CT reports through patient portals (Regev et al., 2023). The study found that patients’ level of concern about specific medical terms was significantly higher than the level of concern those terms elicited among spine surgeons reading the same reports. Direct portal access to imaging reports was associated with anxiety symptoms, particularly in patients prone to worry.
Words matter. Terms like “degeneration,” “tear,” “collapse,” and “impingement” can sound frightening even when the underlying finding is common or unrelated to the pain. MRI reports are written for medical communication, not patient reassurance. Reading one alone, in a portal, at nine at night, is one of the harder ways to encounter your own spine.
Snippet — Report wording can affect outcomes
A 2021 randomized trial found that patients given routine MRI reports had more negative beliefs about their spine and worse function at six weeks than patients given the same information framed in terms of normal age-related change. The wording of the report — separate from the underlying imaging — affects how patients feel and recover.
A plain-English glossary of the most common lumbar MRI terms
If you are reading your report and get stuck on a word, the table below offers plain-English translations of twelve terms that appear most often. These are general explanations, not diagnoses. The same term can mean very different things depending on which level of the spine, how severe the finding is, whether nerves are involved, and how the symptoms and exam line up. The translations are starting points for the conversation — not endpoints.
| MRI Term | Plain-English Translation | What to Keep in Mind |
|---|---|---|
| Disc desiccation | The disc has lost some of its water content over time. | Common with aging. Often present in people without back pain. Not automatically painful. |
| Disc degeneration | Wear-and-tear changes in a disc. | Often part of normal aging. Significance depends on the level affected and the symptoms. |
| Disc bulge | The disc extends slightly beyond its usual border. | Very common, especially with age. May or may not irritate a nerve. Often unrelated to pain. |
| Disc protrusion | A more focused area of disc pushing outward. | May matter when it correlates with specific nerve symptoms. Often does not require surgery. |
| Disc extrusion | Disc material has pushed farther out than a protrusion. | Can be more clinically important, especially with leg pain, numbness, tingling, or weakness. Some extrusions improve without surgery; symptoms and exam guide the decision. |
| Annular tear or fissure | A small split in the outer ring of a disc. | Can be painful in some patients. Can also be incidental. Importance depends on symptoms and location. |
| Thecal sac indentation | A disc, ligament, or bone-related change is touching or pressing on the covering around the spinal nerves. | Sounds alarming. The clinical question is whether there is meaningful nerve compression that matches symptoms. |
| Foraminal narrowing | The opening where a nerve exits the spine is narrower than usual. | Important when it matches pain, numbness, tingling, or weakness in that nerve’s pattern. Less important if symptoms do not match. |
| Central canal stenosis | The main channel that carries the spinal nerves is narrowed. | Can matter when it causes leg symptoms, walking limitation, or neurologic signs. Mild narrowing is often well tolerated. |
| Facet arthropathy | Arthritis-type changes in the small joints at the back of the spine. | Common, especially with age. May contribute to back pain in some patients. Needs correlation with symptoms. |
| Modic changes | Bone marrow signal changes near a disc, often associated with inflammation or wear. | Type and location matter. Some types are more associated with chronic low back pain than others. Read in clinical context. |
| Spondylolisthesis | One vertebra has slipped slightly relative to the one below it. | Severity, stability, and symptoms all matter. Many cases are managed without surgery. |
These translations are general explanations, not a diagnosis. If your report contains a term that worries you, the most useful next step is a conversation with a spine specialist who can read the term in the context of your symptoms, exam, and history.
Snippet — Plain-English MRI glossary
Common lumbar MRI terms include disc desiccation (water loss in a disc), disc bulge (disc extends slightly beyond its usual border), annular tear (a small split in the outer disc ring), thecal sac indentation (mild pressure on the nerve covering), foraminal narrowing (a nerve exit space is narrower), and Modic changes (bone marrow signal changes near a disc). These are general explanations — their importance always depends on symptoms, exam, and clinical context.
At Vertrae®, the MRI gets read in context
Dr. Kamal Woods is a dual fellowship–trained neurosurgeon and spine surgeon specializing exclusively in minimally invasive spine surgery, with advanced training that includes Cedars-Sinai. Vertrae®, a comprehensive, spine-only center led by Dr. Woods, serves patients in Miamisburg, Dayton, and across Southwest Ohio.
At Vertrae®, an MRI report is treated as one piece of the picture — not the entire picture. Dr. Woods reviews the imaging directly, alongside the radiologist’s written interpretation, the patient’s symptoms, the physical exam, and how the pain behaves in real life. The goal is not to chase every finding listed on a report. The goal is to identify which finding, if any, actually matches the pain pattern in front of him.
That sounds simple. In practice, it changes the conversation. A finding labeled “moderate” in a report may be unrelated to the pain. A finding labeled “mild” may turn out to be the most clinically meaningful one. A finding that the report did not emphasize at all may, on direct review of the images, be the one most worth a conversation.
This is part of the through-line of MotionFirst™ spine care: a thorough evaluation, the full range of options clearly laid out, and the patient, not the imaging report, at the center of the decision.
The MRI shows anatomy. Your story shows whether that anatomy matters. |
What this does not mean
This blog is not saying MRI is unimportant. Imaging matters. Sometimes it is decisive. There are situations, such as progressive neurologic symptoms, suspicion of a serious underlying cause, and planning for a specific procedure, where the MRI is essential.
It also does not say that every patient should second-guess their report. For many people, the report and the symptoms line up cleanly, and the path forward is straightforward.
What this blog is saying is more specific. An MRI report is one piece of evidence, written by one radiologist, based on one set of images, at one moment. It is useful, sometimes very useful. It is not the whole story. The whole story includes how the pain behaves, where it goes, what makes it better or worse, what has been tried, and what the patient is trying to get back to.
The most useful sentence after a confusing or frightening MRI report is not “Is the report wrong?” It is, “Does the picture match the pain?” That is a question worth a careful conversation.
Key Takeaway
An MRI report is one radiologist’s written interpretation, not a diagnosis. Research shows that the same lumbar MRI can be reported differently at different centers, that many alarming-sounding findings are common in people without pain, that mild reports do not mean fake pain, and that the wording of a report can itself affect outcomes. At Vertrae® in Miamisburg, Ohio, the imaging is read in context: alongside the symptoms, the exam, and the life the patient is trying to get back to.
Listen to This Topic: What Your Lumbar MRI Report Actually Means
Prefer to listen? This episode breaks down what is on a lumbar MRI report — and what is not. In a clear, conversational format, we discuss why an MRI report is one radiologist’s written interpretation, why the same spine can be read different ways, why scary-sounding findings are often common findings, when MRI findings warrant more urgent attention, and how Vertrae® reads imaging in the context of the patient story and exam.
Read the Full Podcast Transcript
DISCLAIMER:
Transcript lightly edited for clarity and readability. The conversational format is designed to explore concepts and tradeoffs, not to provide medical advice or apply to any individual patient. Outcomes vary by patient, pain pattern, technology used, and study population, and findings from one clinical trial may not generalize to every situation. For guidance specific to your situation, consult a spine specialist.
TRANSCRIPT TEXT:
Speaker 1:
We all know that universal, stomach-dropping moment.
You are sitting on the couch. It is a Sunday night. Your phone pings.
Speaker 2:
The patient portal notification.
Speaker 1:
Exactly. Your lumbar MRI report is ready. And, of course, your doctor has not called yet because it is the weekend. They will not be back in the clinic until Monday, but you feel like you have to click it.
Speaker 2:
You do.
Speaker 1:
Before anyone has explained a single thing, you tap it, open the report, and start reading.
You see phrases like “multilevel disc desiccation,” “annular fissure at L4-L5,” “mild central canal stenosis,” or “disc material indenting the thecal sac.” Suddenly, your back — which may have felt like a dull ache that morning — feels like a crumbling architectural disaster.
Speaker 2:
Because the anxiety of the unknown can completely override logic.
Speaker 1:
Exactly. And by the time the doctor calls the next day, you have read the report 11 times, visited three different websites, and convinced yourself you need a spinal fusion.
Speaker 2:
That is such a common spiral.
Speaker 1:
It really is.
Today, our mission for this deep dive is to pull you out of that internet rabbit hole. We are going to decode the frightening jargon in a lumbar MRI report, explore why the words often sound worse than the reality, and give you a practical plan for what to do with the report sitting open in another tab.
So what does this all mean?
We have to start by reframing your relationship with that document.
Speaker 2:
Why is it written in a way that creates so much anxiety?
Speaker 1:
Because it feels aggressive, right?
Speaker 2:
It does.
Speaker 1:
But part of the reason is that patients are often reading a communication that was originally written for another medical professional.
The radiologist is usually writing for another clinician, often without having met you, examined you, watched you walk, or heard your full clinical story.
Speaker 2:
Which feels strange, but that is how the system works.
Speaker 1:
Exactly. It is not necessarily a flaw in the radiologist’s work, but it means the language is not written to land gently on someone reading it alone at home.
A 2023 study by Regev and colleagues looked at this issue. They studied how patients perceived their own radiology reports after reading them through patient portals.
Speaker 2:
And I imagine patients had a lot of anxiety.
Speaker 1:
They did. Patients often had more concern and anxiety than spine surgeons reading the same types of reports, because the words were being read without the clinical context.
It is like intercepting a mechanic’s raw diagnostic code. The scanner may display something that sounds catastrophic, but the mechanic understands whether it is a major issue or a routine sensor reading.
Speaker 2:
That is a helpful analogy.
Speaker 1:
If we connect this to the bigger picture, an MRI report is a written interpretation of images. It is not the final clinical diagnosis.
And the wording matters. Words can influence how patients feel about their spine and even how they move through recovery.
A 2021 study by Rajasekaran and colleagues looked at the effects of radiology report language. Patients who received routine, heavily medicalized radiology reports had more negative perceptions about their spine and worse outcomes than patients who received the same information framed in a more clinically contextual way.
Speaker 2:
So the same medical information can land very differently depending on how it is explained.
Speaker 1:
Exactly. Words have power.
Now let’s take that power back by translating some of the most feared MRI phrases into plain English.
Speaker 2:
I love that. Let’s do it.
Speaker 1:
First up: disc desiccation.
It sounds like your spine is turning to dust, but it really means the disc has lost some of its water content.
Speaker 2:
Which happens to many people as they age.
Speaker 1:
Exactly. It is common and often means very little on its own.
Next: disc bulge.
That phrase can make people imagine a tire about to explode, but it usually means the disc extends slightly beyond its usual border. Disc bulges are very common and are often unrelated to pain.
Speaker 2:
Good to know.
Speaker 1:
Next: annular fissure.
The word “fissure” sounds dramatic, but it refers to a small split in the outer ring of the disc. Its importance depends on the patient’s symptoms, exam, and overall clinical picture.
Speaker 2:
So it is not automatically a disaster.
Speaker 1:
Exactly.
Next: central canal stenosis.
Stenosis means narrowing. Central canal stenosis means the main channel for the spinal nerves is narrowed. But mild narrowing is often tolerated by the body. It is narrowing, not necessarily a total blockage.
Speaker 2:
That distinction matters.
Speaker 1:
It does.
Finally: thecal sac indentation.
This phrase can sound frightening, but it often means that a disc or bone is touching or pressing slightly on the covering around the spinal nerves.
Speaker 2:
So it does not automatically mean the nerves are being crushed.
Speaker 1:
Correct. It only becomes clinically meaningful if it matches the symptoms, exam findings, and degree of compression.
Now that we know what some of these words mean, the next question is: do these findings actually explain why your back hurts?
Speaker 2:
Often, not by themselves.
Speaker 1:
Exactly.
A major 2015 systematic review by Brinjikji and colleagues showed that imaging findings such as disc degeneration, disc bulges, and other degenerative changes are common in people with no pain at all.
Speaker 2:
Zero pain?
Speaker 1:
Yes. Completely asymptomatic people. Findings like disc degeneration can appear in people as young as their 20s and become more common with age.
Speaker 2:
But does that mean they will develop back pain later?
Speaker 1:
Not necessarily.
A 2022 population-based study by Kasch and colleagues looked at more than 3,000 people and found that many individual degenerative MRI findings had only weak associations with current and future back pain.
Speaker 2:
So if those findings do not always cause pain now and do not reliably predict pain later, what are they?
Speaker 1:
Think of it this way: aging shows up on the spine the way wrinkles show up on the skin.
They can be signs of normal biological aging — not automatically a diagnosis, a source of pain, or a reason for surgery.
Speaker 2:
Spinal wrinkles.
Speaker 1:
Exactly.
But if the same spine can be described in different ways, how much agreement is there between MRI reports?
That brings us to the 2017 Herzog study, which is incredibly important.
Speaker 2:
The Herzog study is fascinating.
Speaker 1:
Researchers sent one patient to 10 different MRI centers over a three-week period. One patient. Same spine. Nearly the same time period.
Across the 10 MRI reports, radiologists described 49 distinct findings. But not one finding appeared in all 10 reports.
Speaker 2:
Not one?
Speaker 1:
Not one.
Now, this does not mean radiologists are careless or that MRI is useless. The lumbar spine is complex, and interpreting images involves medical judgment. But it does show that wording and interpretation can vary significantly from one report to another.
Speaker 2:
So MRI interpretation is part science and part clinical judgment.
Speaker 1:
Exactly. And that is why reports need context.
But we should be careful here: MRIs are absolutely not useless.
Speaker 2:
Right. We need clear guardrails.
Speaker 1:
Imaging is very powerful when the picture matches specific urgent symptoms.
Important warning signs include progressive weakness or numbness in a clear nerve pattern, worsening ability to walk, severe radiating leg pain, or any sudden change in bowel or bladder control. Those symptoms deserve prompt medical evaluation.
Speaker 2:
So the goal is not to ignore the MRI.
Speaker 1:
Correct. The goal is to understand that imaging needs context — and the patient provides that context.
So what should you do next if you have a scary-sounding MRI report?
First, bring the report. But more importantly, bring the actual images. Ask the imaging center for a disc, a USB copy, or a secure link to the image files.
Speaker 2:
Do not rely only on the written report.
Speaker 1:
Exactly.
Second, write down your symptoms and timeline. What makes the pain worse? What makes it better? Does the pain travel? Does it change with walking, sitting, bending, or standing? Did physical therapy, injections, or medications help at all?
Then bring all of that to someone who can read the report, the images, and your story together.
Speaker 2:
That is the approach at Vertrae®.
Speaker 1:
Yes. Vertrae® is a comprehensive, spine-only center in Miamisburg, Ohio, led by Dr. Kamal Woods. Vertrae® serves patients across Dayton, Centerville, Kettering, Beavercreek, and Southwest Ohio.
Patients can request a consultation at Vertrae.com.
The philosophy is exactly what we are talking about today: do not treat the piece of paper in isolation.
A “mild” finding on a report might actually fit the patient’s symptoms, while a “moderate” finding might simply be background noise. Two patients can have similar imaging reports and need very different treatment plans.
Speaker 2:
The scan matters, but the story tells us what the scan means for that specific person.
Speaker 1:
Exactly.
So if you are listening with that patient portal open in another tab, here is the most helpful next step: stop rereading the report over and over.
Reading it a 12th time will probably not give you clarity.
Bring the report, the actual images, and your story to a clinician who can interpret all three together.
Speaker 2:
That is how the report becomes useful instead of frightening.
Speaker 1:
Exactly.
And I want to leave you with one final question:
If our physical experience of pain can be worsened by scary, decontextualized words on a screen, how much of our suffering in other parts of life is shaped by labels we are given rather than the full reality of our condition?
Speaker 2:
That is definitely something to think about.
Speaker 1:
Thank you for joining us on this deep dive. We will see you next time.
Direct CTA — Request a consultation
If your MRI report has raised more questions than answers, start with a focused spine evaluation. At Vertrae®, Dr. Kamal Woods reviews the actual images, the radiologist’s report, your symptoms, your exam, and the life you are trying to get back to — so you can understand what matters and what does not.
Vertrae® is a comprehensive, spine-only center in Miamisburg, Ohio, serving Dayton and the wider Southwest Ohio community.
Frequently Asked Questions
My MRI report was normal but I still have back pain. Is my pain real?
Yes. Most low back pain does not have a single anatomical cause that shows up clearly on imaging. Pain can involve muscles, joints, nerves, inflammation, movement patterns, and how the spine is functioning, not just visible structural changes. Back pain with a normal MRI is common, and the pain is not fictional.
What does disc desiccation mean on my MRI?
Disc desiccation means the disc has lost some of its water content. It is one of the most common findings on lumbar MRI and becomes increasingly common with age. It is often present in people who feel completely fine. Whether it matters in a specific patient depends on symptoms and exam.
Is an annular tear serious?
An annular tear, also called an annular fissure, is a small split in the outer ring of a disc. It can be painful in some patients and incidental in others. Its importance depends on symptoms, location, and whether nerves are involved — not on the term alone.
My disc is indenting the thecal sac. Is that bad?
Not always. The thecal sac surrounds the spinal nerves. Mild indentation can sound alarming, but the clinical question is whether there is meaningful nerve compression that matches the patient’s symptoms. Many cases of mild indentation are not the source of pain.
What are Modic changes on an MRI?
Modic changes are signal changes in the bone marrow near a disc, often associated with inflammation or wear at that level. The type and location of the change matter. Some types are more associated with chronic low back pain than others. They are read in the context of the full clinical picture.
Should I get a second opinion on my lumbar MRI?
A second opinion can be reasonable when symptoms are severe, when a report sounds frightening, when injections or surgery are being considered, or when the MRI report does not match the symptoms. Research has shown that the same lumbar MRI can be reported differently at different centers, with substantial variation between radiologists.
Why is my pain worse than the MRI report suggests?
Pain and MRI findings often do not match. Most low back pain is described as non-specific, meaning no single structural cause is identified. The wording of an MRI report describes what the radiologist sees, not how the spine is functioning or how the pain feels in daily life.
Can a spine specialist read my MRI differently than the radiology report?
Yes. A radiologist’s report is valuable, but a spine specialist reviews the actual images with a different clinical question in mind: does this finding match the patient’s symptoms, exam, and goals? The report describes anatomy. The specialist helps determine which finding, if any, is clinically meaningful.
Can I trust what the MRI report says?
An MRI report is useful information from one radiologist working from one set of images. It is not a diagnosis on its own. The most reliable conclusion comes from reading the images alongside the patient’s symptoms, physical exam, treatment history, and goals.
References (APA 7th Edition)
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173
Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J., Smeets, R. J., & Underwood, M. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356–2367. https://doi.org/10.1016/S0140-6736(18)30480-X
Herzog, R., Elgort, D. R., Flanders, A. E., & Moley, P. J. (2017). Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period. The Spine Journal, 17(4), 554–561. https://doi.org/10.1016/j.spinee.2016.11.009
Kasch, R., Truthmann, J., Hancock, M. J., Maher, C. G., Otto, M., Nell, C., Reichwein, N., Bülow, R., Chenot, J. F., Hofer, A., Wassilew, G., & Schmidt, C. O. (2022). Association of lumbar MRI findings with current and future back pain in a population-based cohort study. Spine, 47(3), 201–211. https://doi.org/10.1097/BRS.0000000000004198
Rajasekaran, S., Dilip Chand Raja, S., Pushpa, B. T., Ananda, K. B., Ajoy Prasad, S., & Rishi, M. K. (2021). The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: Results from an RCT and blinded trials. European Spine Journal, 30(7), 2069–2081. https://doi.org/10.1007/s00586-021-06809-0
Regev, G. J., Treister, R., Brill, S., Ofir, D., Salame, K., Lidar, Z., Khashan, M., Litvin, R., & Hochberg, U. (2023). Low back pain patients’ perceptions regarding their own radiology reports: Pre-intervention survey. Journal of Pain Research, 16, 933–941. https://doi.org/10.2147/JPR.S396844
