Problems in the low back shown by MRI don’t much on their own
Three pages on PainSci cite Borenstein 2001: 1. The Complete Guide to Trigger Points & Myofascial Pain 2. The Complete Guide to Low Back Pain 3. Your Back Is Not Out of Alignment
PainSci commentary on Borenstein 2001: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
In 1989, 21 of 67 perfectly healthy people, with no history of back pain, were scanned with MRI, and found to have “an identifiable abnormality of a disc or of the spinal canal.” Such findings are surprising, but perhaps the effect of such abnormalities is delayed: how were they doing a decade later? The research team followed up with 50 of the original subjects.
Their backs looked somewhat worse — more of the same — but only 21 of them had developed back pain, and not the same 21 that had abnormalities in ‘89. Only 12 of them had any findings on their original scans (and some of those were trivial).
The authors therefore concluded that “the findings on magnetic resonance scans were not predictive of the development or duration of low-back pain” and that “clinical correlation is essential to determine the importance of abnormalities on magnetic resonance images.” MRI findings — and the structural abnormalities that they reveal — are essentially meaningless on their own.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
BACKGROUND: In 1989, a group of sixty-seven asymptomatic individuals with no history of back pain underwent magnetic resonance imaging of the lumbar spine. Twenty-one subjects (31%) had an identifiable abnormality of a disc or of the spinal canal. In the current study, we investigated whether the findings on the scans of the lumbar spine that had been made in 1989 predicted the development of low-back pain in these asymptomatic subjects.
METHODS: A questionnaire concerning the development and duration of low-back pain over a seven-year period was sent to the sixty-seven asymptomatic individuals from the 1989 study. A total of fifty subjects completed and returned the questionnaire. A repeat magnetic resonance scan was made for thirty-one of these subjects. Two neuroradiologists and one orthopaedic spine surgeon interpreted the original and repeat scans in a blinded fashion, independent of clinical information. At each disc level, any radiographic abnormality, including bulging or degeneration of the disc, was identified. Radiographic progression was defined as increasing severity of an abnormality at a specific disc level or the involvement of additional levels.
RESULTS: Of the fifty subjects who returned the questionnaire, twenty-nine (58%) had no back pain. Low-back pain developed in twenty-one subjects during the seven-year study period. The 1989 scans of these subjects demonstrated normal findings in twelve, a herniated disc in five, stenosis in three, and moderate disc degeneration in one. Eight individuals had radiating leg pain; four of them had had normal findings on the original scans, two had had spinal stenosis, one had had a disc protrusion, and one had had a disc extrusion. In general, repeat magnetic resonance imaging scans revealed a greater frequency of disc herniation, bulging, degeneration, and spinal stenosis than did the original scans.
CONCLUSIONS: The findings on magnetic resonance scans were not predictive of the development or duration of low-back pain. Individuals with the longest duration of low-back pain did not have the greatest degree of anatomical abnormality on the original, 1989 scans. Clinical correlation is essential to determine the importance of abnormalities on magnetic resonance images.
related content
- “Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors,” Jarvik et al, Spine (Phila Pa 1976), 2005.
- “Prospective controlled study of the development of lower back pain in previously asymptomatic subjects undergoing experimental discography,” Carragee et al, Spine (Phila Pa 1976), 2004.
- “The Twin Spine Study: contributions to a changing view of disc degeneration,” Battié et al, Spine J, 2009.
- “Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations,” Brinjikji et al, AJNR Am J Neuroradiol, 2015.
- “MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis,” Brinjikji et al, AJNR Am J Neuroradiol, 2015.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomised trials. Wang 2025 BMJ.
- Gabapentinoids and Risk of Hip Fracture. Leung 2024 JAMA Netw Open.
- Classical Conditioning Fails to Elicit Allodynia in an Experimental Study with Healthy Humans. Madden 2017 Pain Med.
- Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial. Kirwan 2024 Br J Sports Med.
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.