symptom
Your Spine MRI Report, Term by Term
The short answer
Most of the alarming words on a spine MRI report describe age-related change rather than injury. Disc desiccation, annular fissure, facet arthropathy and mild foraminal narrowing are common findings in people with no symptoms, and become more common with each decade. A report lists what is present; it does not identify which finding, if any, explains your pain. That match is made by comparing the imaging against the examination, which is why a report read in isolation is frequently more frightening than informative.
Read this before you read your report
A radiologist’s job is to describe everything visible on the images. Leaving something out would be a failure, so the report is a complete catalogue.
A catalogue of every change in a forty-five year old spine reads alarmingly, because most forty-five year old spines have accumulated a number of changes. Very little of that is news.
What the report does not do, and is not trying to do, is say which finding explains your symptoms. That question needs your examination alongside the films, which is why a report read alone is usually more frightening than informative.
The vocabulary
Disc desiccation. The disc has lost water content. This begins earlier in life than most people expect and continues throughout it. Extremely common, frequently silent.
Disc height loss. The disc has flattened, usually following desiccation. Also contributes to narrowing the opening a nerve exits through.
Disc bulge. A broad, generally symmetrical outpouching of the disc wall. Very common with age. Distinct from a herniation, which is focal.
Disc protrusion, extrusion, sequestration. Increasing degrees of herniation. A protrusion stays broad-based; an extrusion pushes further through the wall; a sequestered fragment has separated from the disc entirely. The counterintuitive part: the larger extruded fragments are often the ones most likely to resorb on their own.
Annular fissure or annular tear. A crack in the outer wall of the disc. The word tear sounds acute and traumatic; these are common and frequently asymptomatic.
Modic changes. Signal changes in the bone of the vertebral endplates next to a degenerating disc, graded type 1 to 3. An area of ongoing research interest, and not in itself a diagnosis.
Facet arthropathy. Arthritis of the small joints at the back of each spinal level. Common with age, and relevant to whether motion-preserving surgery suits a level.
Ligamentum flavum hypertrophy. Thickening of the ligament forming the roof of the spinal canal. One of the main contributors to stenosis.
Central canal stenosis. Narrowing of the main canal carrying the nerves. Graded mild, moderate or severe, and those grades correlate loosely with symptoms.
Foraminal or lateral recess narrowing. Narrowing where an individual nerve root exits. Often more relevant to leg or arm symptoms than central narrowing, because it affects a specific root.
Spondylolisthesis. One vertebra has slipped forward on another, graded 1 to 4. Covered on spondylolisthesis, where the point is that stability matters more than grade.
Nerve root abutment, contact, impingement, compression. Increasing degrees of the nerve being touched or squeezed. Abutment is often incidental; compression with matching symptoms is the finding that drives decisions.
Cord signal change or myelomalacia. Change within the spinal cord itself. This one is more significant than most on this list and is covered under cervical stenosis and myelopathy.
The three questions that matter
Whatever the report says, the clinically useful questions are the same.
Which finding matches my symptoms? Not which is most severe on the film, but which one corresponds to where you actually feel things.
Does the examination agree? If the report describes compression of a root and the examination shows exactly that root’s territory affected, the diagnosis is solid.
Would treating it change anything? Some findings are real and still not worth treating.
What not to do with your report
Do not compare it with someone else’s. Two people with similar reports can have completely different symptoms, and the difference is in the patient rather than the paper.
Do not conclude that a long list means a bad spine, or that surgery is inevitable. Most people with findings like these are managed without an operation.
Do bring the actual images to your appointment rather than just the report. That distinction is covered on your first visit, and it is the single most useful thing you can do to get a good answer.
This page is for general education and is not medical advice. It does not create a doctor-patient relationship, and it cannot account for the specifics of your own spine. For guidance about your situation, see a qualified physician. If you think you are having a medical emergency, call 911 or go to the nearest emergency department rather than waiting for an appointment.
Common questions
- My report says degenerative changes. Is that bad?
- It is the expected finding in most adult spines, and its prevalence rises steadily with age. It describes wear rather than damage. Whether it matters depends entirely on whether it explains symptoms you actually have, which the report does not attempt to determine.
- Should I be worried by a long report?
- Length reflects thoroughness rather than severity. A radiologist describes everything visible, because omitting something would be a failure of the report. That produces a list, and the list reads as a catalogue of problems even when most of the items are unremarkable for your age.
- Why did my surgeon say something different from the report?
- Because they are answering a different question. A radiologist describes what is present, working from the images and a short clinical note. A surgeon is asking whether what is present explains this specific patient's symptoms and examination findings. Both can be right.
- Does a bigger herniation mean worse symptoms?
- No. Size correlates poorly with pain. Small herniations in tight spaces can be intensely painful, and large ones can be silent. This is one of the clearest examples of why the film has to be read alongside the patient.