Haemangioma, degenerative disc disease, disc bulge, severe facet degeneration, multiple levels. Here is what each actually means, and why they are usually incidental.
Have you had an MRI scan for a spinal problem, read the report, and found phrases that sound alarming with nobody to explain them?
It is a common experience, and an unnecessarily distressing one. Here are five phrases that appear frequently, sound far worse than they are, and are often incidental findings rather than the cause of your symptoms.
1. Haemangioma
In medicine, a word ending in -oma usually describes some form of tumour, which naturally sounds frightening.
In the spine, a haemangioma is a benign lesion filled with blood vessels. The best way to think of it is as a birthmark of the spine. We see similar things on the skin, where they often resemble a small strawberry-coloured mark. That is all this is, but located in a vertebra.
These are incidental findings and rarely the cause of back pain.
On rare occasions they can cause localised inflammation or bleeding that produces pain. And because a haemangioma is of low density, the bone in that small segment has slightly less structural integrity, so very occasionally you can get a small collapse or fracture, with that vertebra losing a little height relative to the one below.
More often than not, though, it is entirely benign, causes no pain, and should cause no concern.
2. Degenerative disc disease
This is probably the most commonly misunderstood phrase on MRI reports, chiefly because of the word “disease.”
The discs are the cushions between the bones. “Degeneration” is simply a phrase meaning wear and tear, and it comes in different grades and forms. Usually it involves loss of fluid within the disc, so it appears dark compared with a healthier, brighter one. Discs can also harden, the lining can tear, or they can flatten.
Now the important part. A study looked at MRI findings in people of different ages who had no symptoms at all.
Above the age of 50, 80% of people without back pain have disc degeneration.
3. Disc bulge
Another very common phrase, describing a disc bulging outwards compared with the relatively flat ones above and below it.
This too is a common finding, and it is only of concern if the bulge is pinching a nerve and causing pain radiating down the leg, in other words sciatica.
Occasionally the bulge alone can cause back pain, through instability of that disc. The pattern tends to be pain worse when sitting, or when standing for a period, with walking often improving it as the bones above and below move and help the disc settle back into a more stable position.
But frequently it is an incidental finding, and it takes a thorough clinical assessment to establish whether it is genuinely the cause of your pain.
4. Severe facet joint degeneration
The word “severe” is what alarms people, understandably. It is worth knowing that it is a somewhat subjective term.
The facet joints are the joints at the back of the spine, joining the arches at each level. On a cross-sectional MRI slice, taken across your waist and viewed from below, they appear towards the back.
How they are graded, and whether the word “severe” is used, comes down to how much overgrowth there is of the joint and how much wear is inside it. There is a degree of judgement in that.
Facet joint degeneration is again a common finding. Above the age of 50, around 32% of people have it, and it becomes more common with age, including in people with no back pain.
It matters in specific circumstances:
- If the joint has weakened enough to allow a spondylolisthesis, where one bone slips forward relative to the one below, that can genuinely be the source of pain and needs treatment
- If it is so overgrown that it is pinching a nerve, causing leg pain
- If it is so overgrown that it causes stenosis, narrowing the spinal canal, which produces leg pain on standing and walking
As an isolated finding, though, we see it frequently in people with no symptoms at all.
5. Findings at multiple levels
This is the one that frightens people most, and often the least justified.
A report might say: severe disc flattening at L2/3, disc dehydration at L3/4, a fissure of the disc at L4/5, facet joint degeneration at L5/S1.
Every one of those descriptions is something covered above, and every one is a common finding in people without symptoms.
The fact that it is happening at several levels does not mean it is the cause of your pain, or that anything bad is happening. Patients see a list like that and assume their spine is ruined, or, as I often hear, “shot to bits.” That is not the case.
The key takeaway
MRI scans describe your anatomy, and we are all unique in many ways. They do not usually describe the cause of your problems, and that is not their job. It is ours, tying the findings to the clinical picture to see whether they are relevant.
We treat patients, not scans. There is no substitute for a thorough clinical assessment: a proper conversation with a clinician, an examination, and then, if appropriate, a scan to see whether it all ties together.
