Aging occurs in all of our body systems including the spine. Similar to wrinkles and grey hair, the spine will demonstrate age related changes including disk bulges, herniations, facet and ligament changes, as well as, degeneration around age 30. Interestingly, we find a high percentage of these changes in people with and without neck pain. Thus, we need to be careful when interpreting MRI findings in the cervical spine to ensure the pathology in question matches a patient’s clinical presentation. An interesting study was just performed and questioned how changes on a patient’s MRI correlated with their current symptoms.
Daimon and colleagues in this year’s Journal of Bone and Joint Surgery followed pain free individuals over a 20 year period. At the time of the initial MRI all 193 subjects were pain free and physicians documented the degree of cervical degeneration. The authors reported these age related changes progressed in 95% of subjects and affected all spinal levels over the 20 year period. As expected, the rates of spinal changes correlated directly with a patient’s age. Surprisingly, the authors reported no relationship between the progression of this degeneration and the onset of clinical symptoms. One exception was narrowing of the canals (foramen) in the neck. Narrowing of these canals correlated with upper extremity symptoms due to compression of the nerve root.
This study adds to the vast amounts of data documenting the high rates of false positive spinal MRI testing. The lack of specificity of these tests limits their utility unless they can be interpreted with the patient’s current symptoms. Most of these abnormal findings were there before you had neck pain and will be there after successful treatment by a Physical Therapist.