Can we trust MRI findings?

Radiology and surgery in low back pain are presented through a strong emphasis on careful interpretation and communication. The main point is that most low back pain is non-specific, and only a small proportion can be explained by structural findings on X-rays or MRI. Common imaging findings such as disc degeneration, bulges, protrusions, annular tears, spondylolisthesis, and even lumbar stenosis are often seen in people without pain, especially with increasing age, so they do not reliably predict symptoms or future pain. The teaching also highlights the risks of over-relying on imaging. MRI results can vary between centers, may increase fear, worsen perceived prognosis, and may even raise the likelihood of unnecessary surgery or medication use. Learners are encouraged to focus on informed clinical assessment first and use imaging results cautiously and contextually. One important exception discussed is scoliosis in growing children, where visible curves may require referral, especially above 20 degrees, with treatment aimed at preventing progression beyond 45 degrees. Overall, the message is to explain imaging findings in a reassuring way, support patient confidence, and prioritize physical therapy and active back health.