October 25, 2023
October 25, 2023

Understanding Back Pain and How an MRI of the Spine Can Help

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Understanding Back Pain and How an MRI of the Spine Can Help

Whether you’re an athlete, have been in an accident, or are simply getting older, herniated discs are a common cause of low back pain — and an MRI of the spine can determine if this is what you’re experiencing.

Here, we’ll explain what a herniated disc is, risk factors, and what symptoms are commonly associated with this condition. We’ll also explore why an MRI scan is the test of choice and how it can help you become more proactive about your health.

Spinal Anatomy: What Is a Vertebral Disc?

Herniated disc MRI: infographic of a Human Vertebral Column

Before delving into the details of a herniated disc, it’s helpful to understand some basics of spinal anatomy. The spine is responsible for many functions, including our mobility and protecting the spinal cord. The spine is also called the vertebral column, which is made up of cervical, thoracic, lumbar, sacral, and coccygeal vertebrae. In between the vertebrae are joints called intervertebral discs. 

Discs are made up of thick cartilage material that act as shock absorbers in the spine. Discs are comprised of three main parts: nucleus pulposus, annulus fibrosis, and the cartilaginous endplates that link the discs to their surrounding vertebrae. 

The nucleus pulposus is a soft, gel-like structure that is mostly water — it’s responsible for the flexibility of the spine. The annulus fibrosus is a tough but flexible structure that serves as the outer ring of the disc.

What Is a Herniated Disc?

A herniated disc happens when the nucleus pulposus (inner layer) protrudes or pushes through the annulus fibrosus (outer layer). This commonly happens with age as the nucleus pulposus dries up, resulting in decreased strength and flexibility. This degeneration is commonly referred to as degenerative disc disease. Herniated discs also frequently happen with some sort of trauma, due to mechanical force such as a car accident or contact sports. The protrusion or herniation of the disc can lead to various symptoms depending on the area of the spine that is affected.

Risk Factors for Disc Herniation

Disc herniation is most common in people who are 30-50 years old. It’s also twice as common to happen in men. This might be because men are more likely to play contact sports and have jobs requiring heavy lifting. 

There’s also some debate about whether there are anatomical differences between men and women when it comes to the spine. Men may have narrower spinal canals compared to women, which can then lead to more pressure on the discs, increasing the risk of disc herniation. It most commonly happens in the lumbar region of the spine, followed by the cervical region. 

Improper form while lifting heavy objects can increase the risk of a herniated disc along with repeated bending and straining activities on the back. Being overweight and a sedentary lifestyle can also increase the risk of a herniated disc. It’s also thought that smoking can contribute to disc degeneration.

The Four Stages of a Herniated Disc

There are different levels or stages of disc herniation. Symptoms can vary depending on the stage, with some people having no symptoms at all in the early stages. The four stages are as follows:

  1. Disc protrusion: Also called a bulging disc, this is when the nucleus pulposus starts to move from its normal position. This can resolve on its own within a few weeks.
  2. Prolapsed disc: At this stage, the nucleus pulposus starts to become misshapen, which can lead to pain as the disc may begin pressing on nearby nerves.
  3. Disc extrusion: The nucleus pulposus begins to leak out of the disc.
  4. Sequestered disc: This is the most severe stage of disc herniation. All of the nucleus pulposus has been completely pushed out of the disc and may enter the spinal canal or elsewhere in the body.

What Are Common Signs and Symptoms of a Herniated Disc?

Herniated disc MRI: woman holding her lower back

Typically, herniated discs happen in the lower back, or lumbar spine. However, they can also happen in the neck (cervical) and upper back (thoracic) regions. In those cases, you may have neck pain or upper back pain. People with a herniated disc in the lumbar region usually present with lower back pain. This can be after movements like lifting or twisting and the pain is usually sharp or burning in nature. In such instances, a lumbar spine MRI may help to get more detailed information.

Other symptoms can include numbness and tingling if a nerve root is affected. Weakness and trouble walking can be seen in more severe cases where the spinal cord is involved. The type of low back pain commonly seen with a herniated lumbar disc is also called sciatica. This can lead to leg pain that radiates from the back.

How Is a Herniated Disc Diagnosed?

Much of the time, a herniated disc can be suspected by symptoms and a medical provider’s physical exam alone. Diagnostic tests such as X-rays, computed tomography (CT), and magnetic resonance imaging can help in evaluation. 

X-rays can usually be done quickly in an outpatient setting to rule out acute fractures or spine instability. A CT scan is useful for visualizing the spinal bones but does pose some radiation risk. MRI is the most accurate at being able to visualize and locate herniated spinal discs as well as determine their severity. 

What Is an MRI of the Spine?

An MRI scan is an imaging test that uses radio waves to generate high-quality pictures of the area of the body being scanned. Compared to other imaging methods like X-ray and CT scans, MRI does not pose any radiation risk. An MRI of the spine can visualize the spinal bones and the surrounding soft tissues, including ligaments, muscles, blood vessels, and nerves.

MRI has been shown to be the best imaging test when evaluating for disc herniation, with a diagnostic accuracy of 97% for evaluating lumbar disc herniation. While many cases of disc herniation tend to improve with conservative measures within a few weeks, MRI is recommended for those who have severe pain, neurological symptoms suggestive of spinal cord compression, or chronic pain that has lasted for more than six to eight weeks. It can also be a useful tool to better visualize the affected area for pre-operative planning in cases where surgical treatment is recommended. 

How Useful Is an MRI of the Spine?

An MRI scan can be very helpful to determine the cause of back pain that has not improved with typical conservative management. It can also help distinguish a herniated disc from a wide range of other medical conditions that can cause similar symptoms. 

These abnormalities can include:

  • Osteophytes: Bone spurs
  • Synovial cysts: Fluid-filled sacs that form in the joints of the spine
  • Spinal stenosis: This narrowing of the spinal canal can lead to radiculopathy (pain related to nerve root compression) or myelopathy (pain related to spinal cord compression)
  • Spinal tumors: These include both primary tumors that originate in the central nervous system and metastatic lesions that start in another part of the body
  • Epidural abscess: Infection in the epidural space (the space between the inner vertebral canal and the dura mater, the thick outer layer that protects the spinal cord)
  • Epidural hematoma: Blood in the epidural space
  • Cauda equina syndrome: An emergent condition where the nerve roots at the end of the spinal cord are compressed

Herniated Disc Treatment Options

Usually, herniated disc pain improves over time. Up to 90% of cases of lumbar disc herniation resolve within three months when managed conservatively. Treatment options for conservative treatment include various pain relief medications, steroid injections, and physical therapy. If symptoms don’t improve or instead worsen over time, sometimes surgical interventions are recommended. This can include a type of spine surgery called discectomy, where the affected disc is removed. 

Holistic Health: From Your Spine to Your Entire Body

Herniated disc MRI: couple happily hiking together

Herniated discs can be painfully debilitating, with common symptoms including pain in the area of the herniated disc along with numbness and tingling. Fortunately, the majority of cases resolve with time, pain medication, and physical therapy. Since being sedentary and having obesity are associated with an increased risk of disc herniation, lifestyle adjustments like exercising more, ensuring proper form with heavy lifting, and not smoking may help in prevention. 

When you start thinking about how you can detect certain conditions before even developing symptoms, you are actively taking charge of your health. This aligns with getting an Ezra Full Body MRI. Unlike a conventional MRI of the spine, an Ezra Full Body MRI scans the entire body and can detect over 500 different conditions. The scan includes the entire spine and can detect potential herniated discs, spinal cord compression, or vertebral fractures.

Booking a scan is simple and the scan itself only takes one hour. Afterwards, a dedicated radiology team reads your scan and you can discuss your results with an Ezra provider within 7-10 days. When it comes to detecting many medical conditions, the earlier the better. 

Detecting a herniated disc before it has even caused any symptoms empowers you with the knowledge to adjust your lifestyle accordingly. Consider booking your scan today to be proactive about your health and future.