MRI of a Lumbar Disc Herniation

As I mentioned in my first post, you need to use the right tool for the job. When it comes to evaluation of soft tissues, in general, MRI reigns supreme. In the case of low back pain, MRI is essential for detection of disc herniation. However, most low back pain is attributable to muscle strain and pain. That is why most medical society recommendations recommend against immediate imaging. Moreover, the general recommendations are to wait 6 weeks and then perform X-rays even before considering MRI. In fact, most insurance companies will not approve payment for an MRI until this step wise process is followed. The exception to this general rule  includes red flag symptoms. Examples of red flags include a history of cancer, motor or sensory deficits like foot drop, and bowel and/or bladder incontinence.

When an MRI is performed, it provides a detailed view of the lumbar anatomy. A radiologist should comment on the curvature and alignment of the spine. When a vertebral body closer to the head is anterior to the immediately lower vertebral body near the buttock it is called anterolisthesis. If  the above vertebral body is posterior to the lower vertebral body it is called retrolisthesis. The bone marrow is evaluated for edema/inflammation or suspicious lesions/cancer. It is important to note that only the  marrow of the vertebrae is well-appreciated. Cortical bone appears as a black line and is not as clearly seen, hence a CT scan may be necessary to fully evaluate bone spurs. Lastly, the tip of the spinal cord (conus) is evaluated and the descending nerve roots (cauda equina = horses tail).

Then each disc space may be evaluated level by level. A disc herniation (protrusion), extrusion (protrusion that may go up or down in the canal and be larger at its tip than at its base), or sequestered free fragment (broken off and migrated piece of disc) may be characterized. Additionally, the posterior  facet joints (joints that allow you to bend forward and backward) are evaluated for degeneration. This combination of findings can determine spinal canal stenosis and neuroforaminal narrowing (tunnels where nerve roots from your spinal canal exit a bone tunnel to innervate your body). Compression of any of these nerve roots can lead to symptoms.

Take a look at my video to get an idea of what I’m talking about. It  has been a while, but I hope to be back posting monthly so  stay tuned. Let me know what you think and give me a shout out on the comments. Thanks!

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I am an American Board of Radiology certified Diagnostic Radiologist with a certificate of additional qualification in Neuroradiology. I absolutely love my job. I have learned a tremendous amount about the human body, including its’ expected complications given our extraordinary complexity, and get to use that knowledge to help people. I personally have experienced emotional devastation and loss, which has made me compassionate and empathetic. I really care about people, and I hope I can use this site to help you. I graduated medical school in 2004 from New York Medical College. My wife and I had our first son in NY where we bought our 900 sf two bedroom one bath starter home. I stayed at Westchester Medical Center for radiology residency, where we had our second son. I obtained a neuroradiology fellowship position at Yale New Haven Medical Center commuting about an hour and a half each way for a year while we had our third boy. Upon graduation I was fortunate to return to Westchester Medical Center to work in Neuroradiology, Body Imaging, and Women’s Imaging departments, a rarity in academic medicine. Almost a decade later and I am living in a larger home in Reno working in a private practice community based outpatient radiology group which contracts with a rural hospital in Elko, Nevada. My wife and I now have four boys and gave up on the girl. We also have a male Bernese mountain Dog named Helmut and female Newfoundland named Lucy. Despite all its hardships and tremendous struggles, I have an absolutely amazing life, which is a gift I cherish. It’s down to my philosophy. I am a firm believer in teamwork. So much comes down to communication. When healthcare providers talk to each other one-on-one, the patient care is always improved, every time! We might not find an answer to your problem, but our collective knowledge sure can help improve your chances. At Yale the best conference I ever regularly attended was a head and neck tumor board. The head and neck surgeon (otolaryngologist = ENT) presented the patient’s clinical history, the radiologist showed the images, the oncologist discussed the tumor and chemotherapy options, and the patient came to the conference and we all did a physical exam looking into their mouth to directly visualize a tumor. It was incredible! Patients came from far and wide to see this highly trained, world-renowned, humble, Japanese, gentleman surgeon. It was also an epiphany. I found that when I see the patient, talk to them, listen to their story, examine them and discuss the patient with my colleagues, the patient felt better and I had a lot of fun. It’s weird but reminds me of seeing a comedy where it is always funnier in a packed theater with everyone laughing. Knowledge and compassion are both infectious and contagious. My greatest days are helping patients deal with some of their most difficult days, and I am good at it.

2 thoughts on “MRI of a Lumbar Disc Herniation

  1. Thank you for the wonderfully detailed explanation of an lumbar MRI. I have severe spinal stenosis. (I have my spinal MRI on CD.) This enables me to better identify the images and understand how my spinal cord condition affects me. Education opportunities this always help people improve their health status. Thank you.


  2. I currently have been having sharp pain in my upper abdomen and unexplained thoracic back pain. Currently undergoing a battery of tests. Abdominal CT scan, chest x-rays, and thoracic spine x-rays all came out clear. My father died of lung cancer, so regarding my back pain, I am freaking myself out thinking that the radiologist made a mistake when assessing my chest x-ray so I’m using your website to teach myself how to read my own results they gave me on a CD. My fears are probably unfounded (I hope) but regardless, radiology seems extremely interesting.

    Liked by 1 person

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