The relationship between spinal abnormalities, often targeted with surgery, and low-back pain has long been controversial. Over a period of more than 20 years, between 1984 and 2005, many MRI and CT scan studies were conducted on asymptomatic people (i.e. people with no pain or other symptoms) from all walks of life. All of these studies found a large percentage of people with disc bulges or protrusions (contained herniations) or degenerated discs who had no back pain. For instance, a 1990 MRI study of asymptomatic adults found that of those younger than 60, 22% had herniated discs, 54% had bulging discs, and 46% had a degenerative disc. The same study found that among asymptomatic adults older than 60, 36% had a herniated disc, 79% had a bulging disc, and 93% had a degenerative disc.(i) A 1994 study evaluated the frequency of abnormal MRI scans of the lumbar (lower) spine in people without back pain. Only 36% of the 98 asymptomatic participants had normal discs at all levels. The older the individual, the more likely she was to have structural abnormalities of the spine. The authors of the study concluded that given the high prevalence of abnormal findings in asymptomatic individuals and the high prevalence of back pain, the discovery of disc abnormalities in people with back pain may frequently be coincidental, and have nothing to do with their back pain.(ii) Finding that more than 90% of lower-spine MRIs in adults are abnormal, authors of a 1997 review of MRIs for back pain came to similar conclusions.(iii)
The hypothesis that those with abnormal findings would soon develop back pain was disproved in a 2001 study that followed studied individuals for seven years. The findings on the initial MRIs did not predict the development or duration of low-back pain.(iv)
Another diagnostic tool for determining whether a disc is responsible for chronic back pain and surgery, provocative discography, is generally used after positive MRI findings. The procedure involves injecting a contrast dye into the disc space to obtain more information on disc structure and to determine whether the injection provokes pain similar to that usually experienced by the patient. If similar pain is provoked, the patient is considered a candidate for spinal fusion surgery.
Patients who had positive findings on provocative discography and elected to have spinal surgery were compared to those who opted for more conservative treatment—including physical therapy, epidural injections, and medications in a study published in 2014. At long-term follow-up of an average of five years, both groups had improved, and there was no significant difference between the two groups regarding pain, general health status, or disability.(v)
Muscles are much more likely to be the cause of back and neck pain than abnormal discs. Common causes of muscle pain are muscle tension, weakness, stiffness, spasm, and trigger points.(vi) Many people who believe their body is broken, as in the case of abnormal discs, become afraid to move due to fear of causing more injury. Lack of movement exacerbates muscle pain.
This article is an excerpt from The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free.
[i] Boden, S. D., Davis, D. O., Dina, T. S., Patronas, N. J., & Wiesel, S. W. (1990). Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects: a prospective investigation. Journal of Bone and Joint Surgery AM, 72, 403-8.
[ii] Jensen, M., Brant-Zawadzki, M., Obuchowski, N., Modic, M., Malkasian. D., & Ross, J. (1994). Magnetic resonance imaging of the lumbar spine in people without back pain. New England Journal of Medicine, 331(2), 69-72.
[iii] Zimmerman, Robert D. (1997). A Review of Utilization of Diagnostic Imaging in the Evaluation of Patients with Back Pain: The When and What of Back Pain Imaging. Journal of Back and Musculoskeletal Rehabilitation, 8, 125-33.
[iv] Borenstein, G., Boden, S. D., Wiesel, S. W., et al. (2001). The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic individuals: A 7-year follow-up study. Journal of Bone and Joint Surgery AM, 83, 320-34
[v] Smith, J. S., Sidhu, J., Bode, K., Gendelberg, D., Maltenfort, M., Ibrahimi, D., Shaffrey, C. I, Vaccaro, A. R. (2014). Operative and nonoperative treatment approaches for lumbar degenerative disc disease have similar long-term clinical outcomes among patients with positive discography. World Neurosurgery , 82(5), 872-878.
[vi] Marcus. (2012). End Back Pain Forever, 59.