An Introduction to MRI scans

The very first MRI scan of the human being body was performed in 1977. Prior to this, we were basically making educated guesses almost what was incorrect with the spine. Today, the modern practice of spine surgery relies heavily on the interpretation of MRI scans.

MRI scans slice the human torso into thin sections

Magnetic Resonance Imaging creates thin section images of the inside of the human body. This technique allows us to visualize anatomic structures from whatsoever angle and direction. The ii most common slices that we look at on MRI scans of the spine are the sagittal and coronal slices. The saggital plane sections the human body lengthwise. The axial plane creates a cantankerous section of the man body.

MRI axial plane MRI sagittal plane

An MRI image looks like a photo, but it is really a computerized paradigm of the nuclear magnetic resonance of molecules inside the human trunk. These images are superior to CT scans and X-rays. The resolution and clarity of the images is better, we tin meet more fine detail, and this test uses harmless radio waves instead of ionizing radiation.

MRI scans as a medical tool

Magnetic Resonance Imaging is an amazing tool that allows u.s.a. to come across deep inside the human body with a caste of clarity that is admittedly astonishing. Nosotros tin can visualize the tiny details of normal and abnormal human anatomy. We can clearly see the intervertebral discs, spinal cord and nerve roots. In addition to normal anatomy, nosotros have likewise learned to place a number of findings that may crusade neck and arm pain or back and leg pain. The listing of abnormal findings that we can see on an MRI scan include the following:

disc desiccation

disc degeneration

disc jutting

disc herniations

annular tears

spinal stenosis

neuroforaminal narrowing

We are going to look at examples of each of these conditions. Notwithstanding, before nosotros practice, it is important that you sympathize that after the historic period of thirty, essentially every MRI browse of the human body is abnormal.

Every MRI scan after the age of 30 is "abnormal"

These 2 pictures explain why. The natural crumbling procedure causes changes to every structure of the human body. The spine is no different. If we were to wait at the skin of the gentlemen on the right with a microscope, we would see evidence of degeneration, loss of elasticity (which is called elastosis), noncancerous skin growths (called keratoacanthomas), paint changes such as liver spots, and thickening of the skin. These findings would all be described as "abnormal".

MRI scans reveal a natural aging process

Yet, we could depict the pare on the right as "normal for age". We only draw it as abnormal when nosotros compare it to the image of the babe on the left.  Most people, even if they don't have whatsoever back pain, will still have bear witness of abnormalities on MRI scans.  Disc degeneration, jutting disks, and herniated discs occur very commonly and they may not be causing symptoms of pain. For instance, in a paper published in the journal radiology, the researches establish that approximately 90% of people WITHOUT any history of dorsum pain in the last 6 months notwithstanding have show of annular tears, disc degeneration, and disc bulging at one or multiple levels.

Therefore, the critical task when it comes to interpreting MRI scan is CORRELATING the findings on the MRI scan with the patient's complaints and with the concrete examination.

What a normal MRI scan looks like.

This is an MRI scan of a 40 yr quondam male person. In that location are 5 intervertebral discs in the lumbar spine. We are going to get-go with a normal level which has a normal intervertebral disc. Each disc separates two bones called vertebrae in the spine. In this case, this is the L3-iv disc. In a higher place the disc is the L3 vertebral body and beneath the disc is the L4 vertebral torso. The eye of the disc, the annulus pulpous is relatively white. The forepart and back of the disc, the annulus fibrosis is nighttime blackness, thick, and is not bulging into the spinal canal. The spinal culvert is filled with white fluid, chosen cerebrospinal fluid (CSF).  Inside the CSF is the spinal string and the nerve root that go downward to the legs.

normal saggital MRI scan lumbar spine

On the axial paradigm, the neuroforamen are broad open and there is plenty of infinite available for the nervus roots.

normal axial slice MRI lumbar spine

Disc dessication

Using the same MRI scan, let's look at a dessicated disc. Desiccation is the land of dryness, or the process of drying. The theory here is that when nosotros are young, and our discs are immature, our discs have a high water content.

MRI scan lumbar disc dessication When we are young, the eye of the disc, called the annulus fibrosis, has an electric charge that holds onto water very well. The disc is gummy, elastic, and is a good shock absorber. With time, the center of the deejay loses water content and the disk starts to "dry out". I tell patients that all of our intervertebral discs outset out as fatty plump grapes and eventually end upwards like raisins. Just like us.

MRI reveals disc dessicationDisc Degeneration

Disc degeneration is a more than advanced form of disc dessication. In add-on to the nucleus pulposus drying out, the disc starts to collapse.  Bone spurs class effectually the edges of the intervertebral disc. Disc degeneration is the same thing as degenerative arthritis. This condition is inevitable. It's just every bit certain as death and taxes, and it will happen to anybody if they live long plenty. The ane thing that predicts whether or non you will have degeneration of your discs is the number of birthdays you take had. The more birthdays, the more than testify you are sure to have of disc degeneration.

MRI scan shows disc space degeneration

Disc bulging and herniations

Disc bulges and herniations come in all sorts of sizes and shapes. As the disc starts to degenerate, it tin bulge out towards the spinal canal and the nerve roots. This first example is described by the radiologist as a "herniation".  This herniation is nonetheless contained by the annulus.  Equally such, it is probably more than accurate to describe this as a disc burl.

MRI scans focal disk herniation

In dissimilarity, this example shows a actually big disc herniation.  In this case, the nucleus pulposus has herniated completely through the annulus and there is a large gratuitous fragment of disc cloth filling the neural foramen and completely obstructing the normal path for the exiting and traversing nerve roots.

MRI scan large disc herniationAnnular tears on MRI scan

Annular tears are a peculiarly interesting finding on MRI scans. They stand for a partial disc herniation where simply a few of the fibers of the annulus fibrosis remain. Hither is a short video illustrating the typical findings in an annular tear.

Spinal Stenosis and neuroforaminal narrowing: what that looks like on the MRI scan

The end event of all of these changes is spinal stenosis. Stenosis mean "narrowing".  The procedure of disc bulging, degenerative disc affliction, and the development of arthritis of the spine all cause narrowing of the space bachelor for the nerve roots. Here is a short video where I review the MRI scan of someone with two level severe spinal stenosis and illustrates this process.

Making Sense of your MRI scan

Recently, it has become much more mutual to give the patient a copy of the MRI and report from the radiologist.  Unfortunately, this oftentimes creates a lot of confusion and business.

I accept been practicing spine surgery in Monterey, California for more than 12 years.  About 4 or 5 years ago, ObamaCare mandated that patients be given a health intendance summary document when they finished seeing the physician.  This applied to MRI scanners also.  Now, it is very common for the patient to encounter the radiologists report, normally before they see the doctor who ordered the browse.

By the time that a patient sees me, they usually have had the opportunity to read their own MRI report which typically sounds something like:

  • "disc dessication is prominent at L5/S1."
  • "There is broad based disk bulging at L4/5 and L5/S1 and degenerative disk affliction at these two levels."
  • "Complete disc space plummet with prominent osteophytosis is noted at L5-S1"

Patients love Google.  After an hour or two of typing the words they don't recognize on their MRI report into the Google search bar they are scared.  They arrive in my function CONVINCED that there is something dramatically wrong with their back.

I brainstorm by explaining that these findings can exist considered a normal part of aging and that they often occur in patients without dorsum pain or sciatica.

While at that place is a healthy argue almost what constitutes an aberrant versus a normal MRI scan of the spine, there are a few cardinal findings that reveal a problem that we know will require surgery.

If your MRI scan does not show evidence of astringent stenosis, spondylolisthesis, neuroforaminal narrowing, or a large extruded disk hernation, chances are that you tin can probably get meliorate without surgical treatment.

However, the opposite is also truthful.  If you MRI scan shows that you have a big disk herniation, a gratis fragment, severe neuroforaminal narrowing, severe spinal stenosis, or a severe spondylolisthesis, chances are, you may need to accept an functioning subsequently all.  The important thing to do is make sure that yous have the correct functioning.

I specialize in not-fusion, outpatient, microscopic surgery for herniated disks, spinal stenosis, spondylolisthesis, and sciatica. If you call back y'all may be a candidate, I will review your MRI scan to come across if we can assist you.

If you are interested in having me review your MRI scan, you tin can follow this link:

[button url="https://sohrabgolloglymd.com/upload-mri/" target="_blank" color="blue" size="big" border="true" icon="MRI review"]MRI review[/button]

I take also prepared a short video explaining some of your options so that you lot tin make the right determination about spine surgery.