MRI is a great tool and has been shown to be over 90% in specificity, sensitive and accurate in most classifications of lumbar disc herniations. However, the usefulness of this precision is not shown to be greatly meaningful to clinical physical therapy practice. The reason is due to the high number of false positives shown in people without pain, on MRI.
Degenerative changes are commonly found in spine imaging but often occur in pain-free individuals as well as those with back pain. Studies suggest that imaging findings of degenerative changes such as disk degeneration, disk signal loss, disk height loss, disk protrusion, and facet arthropathy/arthritis are generally part of the normal aging process rather than pathologic processes requiring intervention.
Studies have found that >50% of asymptomatic individuals 30–39 years of age have disk degeneration, height loss, or bulging suggests that even in young adults, degenerative changes may be incidental and not causally related to presenting symptoms.
The results from reviews strongly suggest that when degenerative spine findings are incidentally seen (i.e, as part of imaging for an indication other than pain or an incidental disk herniation at a level other than where a patient’s pain localizes), these findings should be considered as normal age-related changes rather than pathologic processes.
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