The Relationship Between Symptoms and Abnormal Magnetic Resonance Images of Lumbar Intervertebral Disks

Although numerous tissues may be involved, injury to the lumbar intervertebral disk (IVD) remains as a prominent source of low back pain (LBP) and lower-extremity radiculopathy.1–5 For the past 60 years, following the influential article by Mixter and Barr,6 an extraordinary amount of research has been published regarding the relationship of lumbar disk degeneration to mechanical abnormalities and pain syndromes involving the low back. New data regarding histochemical properties, mechanical behavior, and factors that predispose the IVD to dysfunction are appearing frequently and have led to much debate about the actual role of the IVD in symptom production. One of the most important advances relating to the evaluation of the IVD comes from the high-resolution in vivo images of the lumbar spine obtained by magnetic resonance imaging (MRI).7 Recent MRI studies of people with and without LBP have yielded surprising results and have led many authors to reexamine the premise that altered disk morphology results in the production of symptoms. This clinical update briefly reviews the traditional views regarding the IVD's role in LBP and lower-extremity radioculopathy and compares them with recent in vivo findings based on lumbar MRI.