Image Findings

Spine Education Models | Patient Education MRI Pathology

Do Image Findings for Spine Relate to Low Back Pain?

a narrative review

It is well known that low back pain IS a pain on the globe1 with certain countries approximating 44% of their population with at least one episode in their lifetime.2 Drilling down on the cause of such back pain has been somewhat challenging to practitioners and researchers.

Even though MRI is often used in the workup of said back pain, it is still questioned whether or not it is always appropriate to use. Some argue that it leads to over-medicalization and unneeded surgeries. Some others believe it may cause catastrophizing and instill fear in patients.

In a recent narrative review on MRI findings like disc bulging, extrusion, disc narrowing, synovial cyst and spondylolisthesis (to name a few), the authors looked to connect these image features with back pain related to ’discogenic’, ‘neuropathic’,’osseous’, ‘facetogenic’, and’paraspinal’.3

What Did These Researchers Find?


After a literature search with a total of 4472 hits, 251 full-text articles were looked at looking at with 31 manuscripts meeting the selection criteria.

The Categories and their associated MRI features:

Discogenic Pfirrmann Grade, Black Disc, Disc Narrowing, Disc Bulging, Annular Fissure
Neurogenic Disc Herniation (extrusion, protrusion), Ligamentum Flavum Hypertrophy, Synovial Cyst, Central Spinal Canal Stenosis, Foraminal Stenosis, Nerve Compression, Epidural Fat
Osseous Modic Changes ( Type1-3), Endplate Defects, Spondylolisthesis, Spondylolysis, Osteomyelitis, Infarction
Facetogenic Facet Tropism, Facet Arthrosis, Facet Fluid Sign, Facet Hypertrophy
Paraspinal Muscle Fat Infiltration, Muscle Cross-sectional Area

Of the 29 considered features classified as discogenic, neurogenic, osseous, facetogenic, and paraspinal, 11 had a positive association with LBP, 2 had mixed results, 7 had no association, and 9 had inconclusive evidence. The relationships between features and their associated pain mechanisms were evaluated to provide an overview of features that are most likely to be associated with LBP. Every feature is discussed separately in each feature category.

The goal of the review was to provide an overview of the available evidence regarding the relationship between specific MRI image features and LBP. Ideally, this yields a list of features strongly associated with LBP, which will aid in radiological reporting and clinical decision-making. Because of this research field’s complex and contradictory nature, caution is advised when drawing conclusions from the literature. The relevant features were carefully reviewed and compared to the currently available literature in this narrative review. The various relationships between MRI features and their associated pain mechanisms were evaluated to provide a list of features that are most likely to be related to LBP. Type I Modic changes, disc degeneration, endplate defects, disc herniation, spinal canal stenosis, nerve compression, and muscle fat infiltration are all on this list.

Furthermore, this review identifies gaps in the current literature and highlights features for which robust evidence is lacking and large-scale studies are required.

Dynamic Disc Designs

At ddd, we create spine education models demonstrating disc dynamics to educate the patients on the findings seen on MRI, CT and x-ray. Some image features are not related to a patient’s pain presentation. Still, other findings can be, and we feel it is important to describe both to patients as it relates to each individual’s presentation. Explore.

DDD Spine Education Models