MRI findings of Spine and its application in Backpain Management
Structure of Spine is complex with a number of pain sensitive structures like muscles, ligaments, facet joints and intervertebral discs.
It is difficult to exactly localize the source of pain causing structure or joint.
- MRI (magnetic resonance imaging) has greatly helped in identifying the exact site of pain or pathology in spine and specialist can co-relate these MRI findings with the clinical profile of the patient and diagnose the exact cause of back pain.
- MRI has revolutionized the management of back pain by helping make exact diagnosis and help treating doctor decide about the treatment plan.
- Medicinal treatment and Physical Therapy is required in most cases of back pain.
- In very few selected cases of back pain surgery is required to treat the diseased area without disturbing the normal structures and adjoining normal part of the spine.
- With precise diagnosis, outcome of the surgery has remarkably improved , complications have drastically reduced and patient satisfaction rates with spine surgery have improved.
- With improved surgical techniques, better Equipment and 3D imaging of the spine provided by MRI, surgery in case of spine diseases has become very safe, precise and very effective.
Usually in practice, General Practitioners (GPs) are first point of contact with the patients suffering from back pain. Patients are advised MRI, CT scan and X-ray by their physicians and when the report comes, patients are further confused and anxious about the findings till they get the opinion from a specialist neurosurgeon.
- Many a times MRI report of the patient mentions terminology like PIVD (prolapse intervertebral disc) L2/3, L3/4, L4/5, L5/S1, annular tear, impingement of nerve roots, facet arthropathy, ligamentum flavum hypertrophy.
- Many of these findings are normal aging process phenomenon and doesn’t require any serious consideration as for as management of back pain is concerned and can be easily managed with simple measures like medication, physiotherapy and other conservative measures
MRI is very helpful in identifying the pathologies like
- herniated discs
- Inflamed facets
- Canal Stenosis
- Recess stenosis
- Synovial Cysts
- Tumours
- Infections like tuberculosis
Urgent MRI is indicated for Cauda Equina Syndrome, Weakness or footdrop, intractable pain, suspicion of malignancy.
When to Consult the Doctor in case of Low Back Pain
Patient should immediately consult a neuro or a spine surgeon, if
- back pain is persistent and doesn’t subside with conservative measures
- numbness or radiating pain present in one or both the legs or arms
- weakness in one or both legs or arms and
- if there is loss of control of bladder or bowels.
Patient’s symptoms of back pain or leg pain or numbness in the legs or groin should not be seen in isolation but should be co-related with radiology findings of MRI/CT/X-ray to find the exact cause of the symptoms. Similarly radiological findings should not be seen in isolation to treat the patient. Sometimes there is mis-match between the clinical details of the patient symptoms and the MRI or radiological findings, in such cases, treating doctor usually go for some other investigations like NCV / EMG studies, work-up for systemic neurological disorders to reach a diagnosis.
If there is co-relation between patient clinical symptoms and radiological findings or MRI findings, management is simple and straight forward in such cases. It can be medical management or a surgical management depending on the extent of the level of compression as per MRI details. It can be mild compression or no compression on MRI scan in which case management is medical. In case the compression is severe, usually surgery is required for such cases. In moderate cases, management whether medical or surgical, depends on the type of pathology, patient’s age and medical fitness and so many other variables.