Posted on Dec 24, 2020
A lumbar MRI can help detect and diagnose a variety of conditions affecting the lower spine, including problems with the spinal cord (such as infection or injury), degeneration of the discs and vertebrae (which can lead to nerve problems), and issues of the surrounding structures (like muscles and ligaments).
But the images produced with lumbar spine MRI are complex. With many nuances, accuracy relies heavily on the skill of the reading radiologist. In a study published by The Spine Journal, the diagnostic error rate for lumbar MRI interpretations was a striking 43.6 percent. We spoke with Dr. Andrew Kompel, a musculoskeletal imaging expert from Boston University School of Medicine, to discuss how patients can ensure their scans get interpreted accurately. In this interview, Dr. Kompel also shares answers to the top five questions patients have about their lumbar spine MRI results and explains why every patient should get a second opinion.
DocPanel is committed to making sure every patient receives excellent care. If you would like an expert second opinion on your medical imaging from Dr. Kompel or one of our other fellowship-trained subspecialty radiologists, you can learn more here.
Selecting the best course of treatment relies upon an accurate diagnosis. A second opinion can help ensure this by confirming the findings on the initial report, allowing you and your doctors to pursue a treatment plan with confidence. Conversely, a second opinion may catch a misdiagnosis, which could be life-saving! Especially before major operations, it’s extremely important to make sure you are treating the correct condition. Otherwise, the procedure could be unnecessary and even harmful. The benefits of a second opinion hold true for studies of the spine, including cervical, thoracic, and lumbar MRI scans, as well as all other areas in medical imaging.
Subspecialty radiologists go through extensive training to develop very specific expertise in one particular area. They then dedicate their entire career to evaluating that one specific area. This specialized training, combined with the deep familiarity that develops with years of practice, enables a radiologist to interpret imaging studies with a greater depth of nuanced understanding. A general radiologist simply won’t have this level of knowledge. But it’s important for ensuring accuracy, especially with complex scans such as lumbar MRIs.
Depending on a patient’s symptoms or condition, the best type of subspecialist for a lumbar spine MRI is either a musculoskeletal radiologist or neuroradiologist. But most of the time, patients are unaware of who is reading their scan. A second opinion can help eliminate this ambiguity in your healthcare. With DocPanel, patients can easily upload their lumbar spine MRI to an online portal and have their images read by a top subspecialty radiologist in the US. All second opinions, regardless of the type of scan, are provided by subspecialists. It’s an extra step, but a small price to pay in ensuring an accurate diagnosis.
NEXT UP: Patient Story Feature - How a Lumbar Spine MRI Second Opinion Led to a Proper Diagnosis
Getting a second opinion from a subspecialist may provide you with additional information. Even if the diagnosis is similar, a differing interpretation of a lumbar MRI can equip you and your doctors with more information to work with.
Research has shown that subspecialists can provide more accurate interpretations and more useful reports - especially when it comes to MRIs. This may help guide your doctors down the correct path so that they can get to a “correct” diagnosis. It also helps ensure appropriate treatment options are provided to the patient.
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In the spine, between the vertebral bodies, there are intervertebral discs that act as cushions. Frequently, portions of these discs can be displaced and may not cause any pain. However, sometimes, these disc fragments can cause compression on an adjacent nerve causing pain or other symptoms including numbness, weakness, or a burning sensation. Recognizing this difference is crucial and can lead to either unnecessary surgery (if there is no compression of nerves) or a potential missed diagnosis.
A lumbar spine MRI can also be used to detect a source of pain that is attributed to something other than the nerves, for example, an issue in the surrounding joints and muscles. Subspecialty radiologists are well aware of the many potential causes of pain and will critically evaluate all the anatomy to ensure any and all sources of pain are correctly identified.
Multiple types of radiology exams can be performed to evaluate the lumbar spine (x-ray, CT, MRI). Of all these exams, lumbar MRI gives the greatest detail of the nerves and spine. This is paramount for an accurate diagnosis, which leads to prompt and appropriate treatments. In addition to evaluating the nerves, MRI can also help doctors examine the surrounding structures (including the bones, joints, and intervertebral discs). The ability to analyze these structures with great detail helps identify the root cause of nerve damage in many patients.
Dr. Kompel shares the answers to commonly asked questions about lumbar spine MRIs.
Question 1: My MRI report was normal but I have back pain. How can this be?
Answer: Unfortunately, this is often the case. A lumbar spine MRI does not identify pain but rather sees abnormal anatomical structures that may be causing pain. And patients need to realize that, in the majority of cases, back pain resolves on its own over time. However, for peace of mind, patients can get a second opinion on their scan to verify the MRI is truly normal, and that no potential causes of pain are being missed.
Question 2: The radiology report mentions many changes in my spine. What does this all mean?
Answer: There are normal changes that occur in the spine with aging and many of the reported findings in a lumbar spine MRI may be age-appropriate. Most people with lower back pain improve with conservative treatments, such as rest and physical therapy. However, a lumbar MRI is important to exclude the possibility of any tumor, nerve compression, or severe narrowing of the spinal canal.
Question 3: Which findings on my MRI spine are the most concerning/ potentially causing my pain?
Answer: Your lumbar spine MRI is read by a radiologist who creates a detailed report of all the changes of the lumbar region, including the spinal column, nerves, muscles, and joints. However, the significance of any finding can depend on the severity and specific symptoms you are experiencing. Therefore, discussing the MRI findings with a spine specialist can help determine the importance of the findings and how they specifically can relate to your symptoms.
Question 4: What is a disc herniation?
Answer: A disc herniation is commonly referred to as a “slipped disc”. The discs are “soft” structures located between the bony vertebral bodies and act as shock absorbers. With an injury, lifting or spontaneously, portions of the disc may become displaced. While a herniated disc itself may not be painful, the displaced material may compress a nerve or the spinal cord potentially leading to symptoms including weakness, numbness, or pain radiating down the leg.
Question: What is spinal stenosis?
Answer: The central opening in the spine where the spinal cord and nerves travel is called the central canal. The central canal is formed by the vertebrae. Anteriorly, the vertebrae are separated by intervertebral discs, and posteriorly, the vertebrae contact each other at regions called facet joints. Additionally, lining the posterior aspect of the central canal are ligaments that are normally thin. With normal aging, portions of the disc can start to extend into the central canal, and enlargement at the facet joints and ligaments can occur from degenerative changes resulting in narrowing (also called stenosis) of the central canal. Symptoms can start to occur because as the central canal becomes progressively more narrow, the spinal cord and nerves may begin to become compressed or displaced.
While conditions of the spine can be tricky to diagnose, lumbar MRI has the potential to provide important pieces to the puzzle. Having a second pair of eyes review your scan can further help you and your doctors come to an accurate diagnosis.