In previous blogs we have discussed the limitations of imaging, including MRI, for musculoskeletal conditions including low back pain. The presence of pathology including disc herniations, nerve compression, arthritis, and degenerative disc disease increases with age in both pain free and painful individuals. The high degree of positive findings among asymptomatic individuals questions the ability of the scan alone to determine the source of a patient’s symptoms. Instead any imaging findings must be correlated to a patient’s subjective history and clinical examination. Another common finding is noted when imaging the same patient twice over the course of their recovery. Previous researchers have shown a high probability of disc regression (improvement) over time with conservative care including Physical Therapy even among more severe disc injuries such as sequestration and extrusion.
A recent systematic review of the evidence was conducted to determine the incidence of improvement in lower back disc injuries treated without surgery (Wang et al. BMC Musculoskeletal Disorders. 2020). Authors included 38 studies of over 2,000 patients with symptomatic lumbar disc injuries. Upon repeated MRI testing over 1400 or 63% demonstrated some degree of improvement or regression. Interestingly, prior studies have also shown improvement in patient symptoms following Physical Therapy or surgery despite no significant changes in their MRI. Based on the available evidence these authors suggested a trial of conservative care including Physical Therapy up to 4 to 10 months before deciding on surgery for non progressing lumbar disc injuries.