So your insurance has finally authorized your spine MRI after months of trying to prove that it is medically necessary. The big day finally arrives, and after it is finished you’re sent home with the radiologist’s report and told to follow up with your physician next week. It may be tempting to read the report and try to interpret meaning from it that will help you to understand what is going on with your back. Curiosity is a natural Human instinct after all. But the language doctors use to communicate with each other may end up leaving you confused and more afraid. So to help you interpret your report, we will be covering some terms that you might see on it.
NOTE: This article is an educational tool only, and not a diagnostic tool. MRIs can never identify the source of pain. They only show structural changes in your anatomy. Pain is a physiological condition and the proper interpretation of symptoms can only be performed through physical examination and professional symptom analysis. The Deuk Spine Institute offers telemedicine examinations via mri.deukspine.com if you have any further questions about your current diagnosis or recommendation.
Spinal Stenosis: Also known as spinal encroachment or spinal narrowing is a constriction of the space within the spine. Narrowing is the key word to remember here. There are several kinds of stenosis and each has different implications for treatment, and almost all of them can be treated with the correct surgery.
Foraminal Stenosis: Foraminal stenosis is the second most common type of spinal narrowing. Foraminal stenosis involves narrowing of the neuroforamen where the nerve roots exit the spinal canal and go down the arm or leg. Foramenal stenosis can occur due to several different conditions such as degenerated disc, herniated disc, facet hypertrophy, facet arthropathy, ligament thickening, short pedicles, and bone spurs. This signifies a narrowing or compression of the space between the neuroforamen, which are a pair of openings to either side of the vertebrae that allow nerves to pass through.
Lateral Recess Stenosis: This is the most common type of spinal stenosis in the lower back. Narrowing occurs medial to the pedicles and is due to facet joint hypertrophy, short pedicles, and disc herniations.
Central Stenosis: Also known as central canal stenosis, it is the least common type of spinal stenosis. When it occurs in the neck it can cause damage to the spinal cord, which is called myelopathy.
When stenosis is identified on your MRI report, it may be cause for your physician to look in to the possibility of nerve impingement, known as radiculopathy. This dysfunction occurs when nerves are compressed, and the signals they typically transmit to other parts of your body become limited by the injury. Whether it is central, foraminal, or lateral recess stenosis, you may experience nerve symptoms with any of them.
Disc Protrusion: Also known as disc herniation, disc bulge, ruptured disc, slipped disc, herniated nucleus pulposus, or prolapsed disc among others. These terms are all related to the same condition, a damaged spinal disc. When it is identified on your report, it means that at the level specified you have a tear in the tough outer layer of your vertebral disc (annulus fibrosis) and through that tear some of the soft material from inside of the disc (nucleus pulposis) has been squeezed out, almost like poking a hole in a balloon full of playdough.
Annulus Fibrosis: This is the tough outer layer of your disc. It is a ring of collagen that surrounds the soft shock-absorbing interior. When your disc herniates, the nucleus pulposis forces its way out through a tear in this ring of tissue that resulted from a prior injury to the annulus fibrosis. Common causes of injury include motor vehicle accidents, work injuries, sports injuries, slip and fall, and repetitive motion injuries.
Nucleus Pulposis: This is the soft gelatinous interior of your disc. It absorbs the shock of bodily motion and movement down through your spine. It remains in the center of your disc unless there is a tear present in the annulus where it presents the path of least resistance and allows the nucleus pulposis to push its way out in to the surrounding spaces.
Spondylolisthesis: This term refers to the relative position of your spinal vertebrae. The word spondy relates to the spine and the word listhesis refers to slippage. There are several types of spondyloslisthesis and different grades for each.
Retrolisthesis: is a posterior or backwards slippage, where one vertebral body has slid backwards and is now resting posteriorly relative to the vertebrae below it.
Anterolisthesis: is an anterior or forward slippage, where one vertebral body has slid forward and is now resting anteriorly relative to the vertebrae below it.
Lateral Listhesis: The bones slip sideways relative to each other resulting in scoliosis.
The grades of a spondylolisthesis go from 1 to 5. A grade 1 is only 25% slippage, up to 50% for grade 2, 75% for grade 3, 100% for grade 4, and then grade 5 which means your vertebral body has completely fallen out of your spine (called spondyloptosis) grade 5 is one of the most uncommon, and typically any grade below a 3 won’t need urgent treatment to correct spinal deformity. However grade 3-4 slippage may need to be corrected with surgery if they are resulting in herniations and severe destabilization of the spine.
Joint Hypertrophy: When hypertrophy is indicated on the report in any capacity, it refers to a certain structure that has enlarged in size. There are different types of hypertrophy, just like there are different types of stenosis in the spine.
Facet Hypertrophy: This indicates an enlargement of the facet joints, or a swelling of the joints which may be indicative of chronic inflammation and underlying diseases like arthritis.
Uncovertebral Hypertrophy: These are joints located in your cervical spine adjacent to each vertebrae. Hypertrophy in these joints may be indicative of bone spurs (known as disc osteophytes or a disc osteophyte complex) and can cause similar issues with neck and arm pain.
WARNING: Adjectives used in an MRI report such as mild, minimal, small, insignificant, or nominal are all subjective and based on the size and appearance alone. Radiologist’s terms have no correlation whatsoever to the patient’s presenting symptoms that may be emanating or originating from the specified area. We strongly recommend you disregard these descriptive terms and obtain an opinion from an experienced clinician to better understand the implication of the abnormality identified. Deuk Spine Institute offers free evaluation and teleconferences to discuss the findings in depth to help you understand the source of your symptoms which may not at first be apparent from the MRI report.
Now that we’ve covered some of the most common terminology that may appear on your MRI report, let’s go over an example and extrapolate the information from it.
If your MRI Report identifies the findings as the following;
“There is left uncovertebral joint hypertrophy at C4-5 causing mild left neural foraminal stenosis. At C5-6 there is a mild broad-based central disc protrusion. The central canal and neural foramina are within normal limits.”
Broken down, the radiologist is reporting that the patient has NARROWING (stenosis) at the LEFT nerve root of C4-5 due to HYPERTROPHY (swelling) of the joint tissue. This may correlate with pain/numbness in the LEFT arm, or the left hand. They are also reporting a mild PROTRUSION (blown-out disc) at C5-6, but NO notable narrowing. Which means this disc may not be the source of any pain or nerve symptoms.
This is just one example, and some radiologists use different language. But this key should be helpful while trying to read and understand the report that was given to you.
For further assistance understanding your diagnosis, visit MRI.DEUKSPINE.COM where the Deuk Spine Foundation provides free telemedicine consultations and MRI reviews. Our team of professional physicians can help you interpret the information in your report and give you a proper medical opinion.