A disc showed on my MRI. Do I need surgery?
Disc bulges are also found in many people with no back pain. An MRI result only means something when it is read alongside your symptoms and examination.
You collect your MRI report, see words like “bulging”, “protrusion” and “degeneration”, and a few hours later you are deep in the internet. Before you conclude anything, know this: many of these words describe your age more than your illness.
What was found in people without pain
A 2015 scientific review pooled the imaging of 3,110 people who had no back pain. Disc bulges were found in 30% of twenty-year-olds and 84% of eighty-year-olds. Disc degeneration rose from 37% at twenty to 96% at eighty.
The researchers concluded that many of these findings are part of normal ageing and are not necessarily the cause of pain. The NHS also says many people never know they have a slipped disc.
So what is an MRI for?
An MRI helps when it is read with a specific question: does this finding match my symptoms?
An example: pain runs from the buttock to the back of the left calf, and the examination shows weakness of that same nerve. If the MRI shows a disc pressing on that same nerve root on the left, the image fits the symptoms. But if the same disc is on the right, or you only have back pain with no leg pain, the story is different.
That is why a surgeon looks at the image itself, not only the report. The report says what was seen, and the examination says which part matters.
A few common words
- Degeneration: a usual change with age.
- Bulging: the disc has come slightly past the edge of the bone.
- Protrusion or herniation: part of the disc has pushed out further.
- Canal or foraminal stenosis: the nerve has less room to pass.
These words do not show how severe your pain is.
So what should I do?
- If it has just begun, treatment usually starts with staying active and no surgery. Sciatica symptoms improve with time in about 9 out of 10 people.
- If you are no better after a few weeks, or weakness and numbness get worse, see a specialist and bring the images themselves.
- If you have any of the warning signs, do not wait for an appointment.
An MRI report does not decide on its own. The decision comes from putting the image, the symptoms and the examination together.