In the absence of rare spine pathology the only abnormal low back MRI is a normal MRI. After age 30 many of our spines will age and positive findings will become more common in patients with and without back pain. MRIs have tremendous sensitivity and can find even the smallest amount of pathology, but their specificity is lacking in patients with low back pain. Multiple studies have shown high rates of spinal pathology among asymptomatic groups of individuals. A recent study highlighted the presence of spinal pathology among an elite group of athletes.
Wasserman and colleagues retrospectively analyzed spinal MRIs of Olympic athletes from the 2016 Rio Summer Games (BMJ. 2018). The authors reported 100 olympic athletes underwent a spinal MRI during the games and half of these high performing athletes were diagnosed with moderate to severe spinal disease. Consistent with previous MRI studies, athletes over 30 years old had the highest rates of spinal disease on MRI. The majority of athletes likely had positive findings on MRI before they had back pain and will have the same findings when their back pain is resolved. Patients are encouraged to have their MRI findings read in light of their subjective and clinical examination to determine which spinal changes are due to age and which may be causing their current symptoms.