MRI to Diagnose a Herniated Disc

MRI to Diagnose a Herniated Disc

Magnetic Resonance Imaging, also known as MRI, is one of modern medicine’s most important inventions. The MRI allows surgeons to accurately diagnose and treat conditions that could potentially lead to life-threatening complications. MRIs can be useful in many areas of medicine, but they are especially helpful in the investigation of conditions in the spine. MRI scans of herniated discs can be a useful test to pinpoint the exact location and extent of the problem. Patients complaining of symptoms due to herniated discs should get an MRI scan performed first.

MRI scans are the most non-invasive way to detect bulging and herniated discs. With an MRI scan doctors can pinpoint herniated discs in their spine with over 95% accuracy due to the high spatial resolution of the spinal anatomy. 

CT scans are not safe and can be inaccurate due to factors that decrease the visibility of soft tissue structural changes caused by a herniated disc. CT scans are the best way to examine spinal alignment and bony problems such as spine fractures. MRI scans can provide a detailed representation of the spinal discs as well as any problems that may be occurring around them, such degeneration or inflammation. MRI is the best method to evaluate disc injuries.

What is a Herniated Disc MRI? And When Might You Need One

MRI scans can be used to diagnose and monitor herniated discs. They are most commonly used to determine the location of herniated discs in the spine and determine the extent of nerve compression. Your doctor may recommend additional tests if the MRI results show a herniated disc. MRIs can be used to diagnose bulging discs or herniated discs in the neck or back.

What your doctor might do

The technician performing your MRI will place your body in a tube-like device after your doctor has ordered it. The magnet rotates around the patient’s body to change the excitation level of hydrogen atoms in tissues. After the magnetic field has been removed, hydrogen atoms will return to their normal resonance state. The scanner may detect this energy to create the image known as an MRI scan.

An MRI scan image generated by the scanner shows anatomy. It distinguishes between tissues that have a lot of water (such cerebrospinal fluid, discs, or other fluids) and those with less water (such skin, bone, cartilage and nerve roots).  Your doctor will inspect the image for any abnormalities to diagnose your condition. MRI scans can detect disc injuries like a bulging disc, bulging disc, or annular tear that causes back pain or pinched nerve.

MRI protocol

It is very easy to use MRI for the examination of the lumbar spine of patients suffering from nerve compression symptoms. We rely on the T1W and T2W images of the sagittal and correlate them with the T2W images of the suspected levels. You should not use a saturation line on the anterior or rectangular field of vision (RFOV) because you want to image prevertebral soft tissue.

Low back pain can also be caused by an aneurysm in the abdominal aorta. Sometimes, it is difficult to distinguish neurogenic claudication (which is caused by spinal stenosis) from vascular claudication (which is caused by arterial stenosis). The frequency-encoding should take place in the AP direction and, consequently, the phase-encoding feet head.

There are many benefits to this:

  1. The frequency-encoded direction has the best resolution.
  2. To find small herniations or delineation nerve roots, we need the best resolution in the AP direction.
  3. Breathing artifacts are created when the phase encoding is in the AP direction. This is why some people use the RFOV or a saturation band.
  4. These problems are eliminated with frequency-encoding in AP-direction. You don’t even need a saturation band.
  5. Frequency encoding can cause poor delineation in the feet-head direction due to a chemical shift artifact, which occurs when the fat in a vertebral body meets water in a disc.
  6. Another reason to use an AP frequency encoder and a feet-head phase encryption is this.

It is preferable to keep the slices parallel to the nerve compression level. This method has the advantage of allowing you to follow the affected nerve through the four levels of possible compression. If you look at multiple levels of angulation, such as the one shown on the right above, you won’t be able to follow all the nerve tracts. You will also not see the whole picture.

How to read an MRI of a Herniated Disc

There are many factors that affect the interpretation of an MRI scanner. Similar to other diagnostic tests, the problem with MRI scans is that the “disorder”, as it appears on the MRI scan, may not be the source of backaches.

A lumbar MRI scan of a herniated disc will be accurate if the patient has a basic understanding about the anatomy of the lumbar spine. There are five components to the lower back. They are separated by two types of joint, facet and discs. These discs are often in constant motion, which causes wear and tear. An annular tear is when the outer disc layer ruptures and the inner nucleus jelly of the disc pushes into the spinal canal, forming a hernia. An MRI scan will often reveal this hernia as a contrast spot.

The patient’s physiological symptoms and experiences will guide MRI scan results. A herniated disc may not cause symptoms, so there are many people who have undiagnosed back conditions. If the herniated disc becomes protruding or bulging, it can cause severe pains. 

The most common cause of back pain is when the herniated disc becomes inflamed along a posterior annular tear. This causes pain signals to travel via a sinu-vertebral neural located along the margin -in of the annulus fibrosus.  The nerve fibers running along the annulus fibrosus posterior wall are somatic pain fibers (SA) and will project their pain signals into a part of the brain that is responsible for highly localized pain, the primary somatosensory cortex.

Evaluation of MRI Scan Results

The first problem with MRI scans, like many other diagnostic studies, is that the “abnormality”, which shows up on the MRI scan, may not be the reason for back pain. Many clinical studies have found that around 30% of people in their thirties or forties show a lumbar disc herniation on an MRI scan. However, they don’t have back pain.

An MRI scan can’t be interpreted by itself. Every detail on an MRI scan must be correlated with the patient’s individual situation.

  • The symptoms (such as the severity, duration, and location of pain)
  • Any neurological deficiencies that are detected during a physical examination

The timing of the scan is also important when MRI scans are being done. An MRI scan will not be required if a patient is experiencing any of the following:

  • Incontinence in the bladder or bowel
  • Nerve damage can cause progressive weakness in the legs.

How to get an MRI scan to diagnose back problems

MRI scans are recommended for patients with leg pain that is not due to a lumbar disc herniation. Because surgery to repair a lumbar disc herniation usually has few side effects (morbidity), and allows for an early return of normal function.

Patients suffering from primarily lower back pain should consider lumbar spine fusion. This type of spine surgery can have some side effects (morbidity) that may be more severe than expected and take longer to heal. Doctors recommend that patients wait 3 to 6 months after the onset of low-back pain before getting an MRI scan to determine if conservative (nonsurgical)treatments will be able to alleviate the pain.

In most cases, if the results from the MRI scan do not affect a patient’s future back pain treatment, and the patient continues with non-surgical treatments like chiropractic treatments and physical therapy, then waiting to have an MRI scan is a reasonable option.

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Kevin Pauza, M.D.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Travis Foxx, M.D. - Premier Anesthesiology & Pain

Kevin Pauza, M.D. - Turtle Creek Surgery Center

Prior to attending Penn State University, Dr. Pauza earned his undergraduate degree from Lehigh University, and furthered his training with a Surgical and Medical Internship at Columbia University College of Physicians and Surgeons. He continued his specialty training at the University of Pennsylvania, followed by an Interventional Spine Fellowship. In addition to his research, philanthropic, and clinical endeavors, Dr. Pauza remains a motivated educator. He established a Spine Fellowship program and continues training physicians from around the world. He heads international committees responsible for establishing standards and educating surgical and non-surgical physicians.

After helping hundreds of patients who failed to experience relief after spine surgery, it became evident to Dr. Pauza that current methods needed to change. This motivated him to seek better ways to help patients, by thinking outside the box.

Dr. Pauza is the first physician in history to pursue FDA approval for using biologics to treat the spine. Millions of patients will benefit from his development of minimally invasive treatments for degenerative disc disease and other more common and serious disorders of the spine.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Brandon Tolman, D.O. - Nashville Spine Institute

Boris Terebuh, M.D. - Regenerative Spine & Joint Center

Boris Terebuh, MD specializes in providing personalized nonsurgical solutions for spine problems that interfere with the function patients desire and the independence they deserve. Dr. Terebuh completed his Physical Medicine & Rehabilitation residency training at The Ohio State University in 1997 and has been in solo practice in Ohio since 2001 because he is committed to providing accessible, individualized and attentive care to his patients. His regenerative approach to solving spine problems enhances the body’s natural ability to heal itself. His guiding principle is integrity – doing what is right for patients in a conscientious manner with the motivation of helping them become fully functional, independent and satisfied. Dr. Terebuh is a very unique Medical Doctor because he has earned seven Board Certifications in the field of musculoskeletal medicine and nonsurgical spine care. Boris Terebuh, MD is delighted to be a Discseel® provider because this revolutionary new technology aligns perfectly with his preferred regenerative treatment approach and patient care philosophy. Dr. Terebuh is also grateful to Discseel® developer, Kevin Pauza, MD, for all the years of diligent and meticulous research to create this innovative, paradigm-shifting intervention, which will certainly spare countless individuals the prospect of avoidable spine surgical procedures.

Thierry Bonnabesse, M.D. - Champlain Spine and Pain Management

Gregory Lutz, M.D. - Regenerative Sportscare Institute

Dr. Gregory Lutz is the Founder and Medical Director of the Regenerative SportsCare Institute (RSI). In addition, he currently serves as Physiatrist-In-Chief Emeritus at Hospital for Special Surgery (HSS) and a Professor of Clinical Rehabilitation Medicine at Weill Medical College of Cornell University. Dr. Lutz is one of the world’s leading experts in the field of regenerative interventional orthopedic medicine, appearing annually on Castle Connolly’s and New York Magazine’s “Top Doctors” lists.

Janet Pearl, M.D. - The Boston Stem Cell Center

Dr. Janet Pearl has been in practice since 1999 and is the Medical Director of The Boston Stem Cell Center. She is also the Medical Director of  Complete Spine and Pain Care  an interventional integrated Pain Management practice, both located in Framingham, Massachusetts. Dr. Pearl is Triple Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology and has over 20 years experience in doing these procedures.

Previously, Dr. Pearl was the Co-Director of the Pain Management Center at St. Elizabeth’s Medical Center, where she was also the Director of the Pain Management Fellowship program.

After graduating from Harvard College with an A.B. in Applied Mathematics with Economics, Dr. Pearl received a M.Sc. in Health Planning and Financing at the London School of Hygiene and Tropical Medicine. She then received her M.D. from the Columbia College of Physicians and Surgeons, where she represented the Medical School as a senator in the Columbia University Senate.

Watch Dr Pearl give an introduction to The Boston Stem Cell Center

Dr. Pearl completed her internship in Internal Medicine at New England Deaconess Hospital, her residency in Anesthesiology at the Massachusetts General Hospital, and her fellowship in Pain Management at the Brigham and Women’s Hospital. Dr. Pearl was the first resident ever to serve on the Accreditation Council for Graduate Medical Education (ACGME)’s Residency Review Committee for Anesthesiology. She is a Joseph Collins Scholar and a Rotary Scholar and was awarded the AMA/Glaxo Welcome and AMA/Burroughs Welcome Resident Leadership Awards.

From 2004 to 2010, Dr. Pearl served on the University of Massachusetts Board of Trustees. While there she chaired the Committee on Science, Technology and Research, was a member of the Committee on Academic and Student Affairs and the Governance Committee and also served as Vice Chair of the Advancement Committee, and as a member of the Committee on Athletics.

Dr. Pearl is Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology with the American Board of Regenerative Medicine and the American Board of Anesthesiologists.

Memberships:

  • The American Pain Society;
  • The Massachusetts Medical Society;
  • The Massachusetts Society of Anesthesiologists;
  • The Massachusetts Society of Interventional Pain Physicians;
  • The American Society of Anesthesiologists;
  • The American Society of International Pain Physicians;
  • The American Institute of Ultrasound in Medicine; and,
  • The American Board of Regenerative Medicine.

PUBLIC SERVICE:

  • Member, Massachusetts Department of Industrial Accidents, Health Care Services Board 
  • Member of the Association of Harvard College Class Secretaries and Treasurers
  • Past Member of the Board of Directors of the Harvard Alumni Association
  • Former Member of the Board of Trustees University of Massachusetts. (10/2010 – 10/2014) 

Mark Reecer, M.D. - Fort Wayne Physical Medicine

Dr. Mark Reecer is board certified in Physical Medicine & Rehabilitation and Pain Management. He has over 20 years of work comp experience, and he routinely provides Independent Medical Examinations (IMEs) for the Indiana Workers’ Compensation Board. Dr. Reecer has lectured extensively and has authored multiple publications that promote his specialty and the use of treatment modalities to eliminate pain, improve function and avoid surgery.

Dmitry Buyanov, M.D. - IV Infusion Treatment Center

Dr. Buyanov is originally from Kiev, Ukraine. He received his training in Anesthesiology and his Interventional Pain Management Post-Doctoral at Penn State Medical Center, PA. Dr. Buyanov moved to San Antonio in 2003 at which time he was part of a multi-specialty group before he founded Premier Pain Consultants in 2004. His practice has over 5000 active patients in his practice. Dr. Buyanov treats his patients in a cost-effective manner although giving them the best care with interventional pain treatments/procedure to help each patient improve their quality of life. Dr. Buyanov strongly believes in an individualized and multidisciplinary approach to pain management, he believes in the Buddhist saying: “pain is inevitable but suffering is optional”. He works closely with the area internists, physical therapists, chiropractors, psychiatrists, neurologists, and spine surgeons to insure that each patient has the most optimal individualized treatment plan. Dr. Buyanov enjoys spending his spare time with his children.

Desmond Hussey, M.D. - NASA Neuroscience and Spine Associates. P.L

Dr. Hussey earned his undergraduate degree from Dartmouth College, and proceeded to earn his Medical Degree from The University of Miami School of Medicine. He then attended Northwestern University Internal Medicine Program, followed by a Neurology Residency Program at Emory University. Dr. Hussey continued his specialty training at John Hopkins University pain clinic. A member of The Spinal Injection Society and The American Academy of Neurology and Psychiatry.

Haley Burke, M.D. - Colorado Rehabilitation and Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Maxim Moradian, M.D. - Interventional Spine Care & Orthopedic Regenerative Experts

Dr. Moradian is triple-board certified in Physical Medicine and Rehabilitation (PM&R), Sports Medicine and Pain Management. Dr. Moradian’s clinical practice is devoted to the comprehensive care of spine, joint, muscle, tendon, ligament, and peripheral nerve disorders. He is proficient in performing advanced, minimally-invasive procedures under fluoroscopic and/or ultrasound guidance in the entire spine. Dr. Moradian performs electrodiagnostic testing (EMG/NCS) for the accurate diagnosis of muscle and/or nerve disorders. He has a special interest in regenerative medicine, sports concussions, neuromuscular ultrasound, medical education, and clinical research. His true passion is to treat his patients like his family and friends.

Wendi Lundquist, D.O. - Active Life Physical Medicine & Pain Center

Dr. Lundquist is the Medical Director and founder of Active Life Physical Medicine & Pain Center, Innovative Surgery Center, and Regena Spa. She is dual board certified in Physical Medicine and Rehabilitation along with Pain Management and a diplomat with the American Board of Pain Medicine. She completed her training at Loyola University in Chicago, Illinois in July of 2005. During her time there, she served as Chief Resident and was involved in several research projects. Prior to, she completed medical school at Midwestern University at the Arizona College of Osteopathic Medicine campus in Glendale, Arizona and internship at Doctors Hospital in Massillon, Ohio. She also has a Bachelor of Science in Biology and minor in Chemistry from the University of New Mexico in Albuquerque. She has a special interest in sports medicine, pain and spine. With 17 years experience, she has great enthusiasm towards regenerative medicine.

Yasuyuki Nonaka, M.D. - Nonaka Lumbago Clinic

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Matthias H. Wiederholz, M.D. - Performance Pain and Sports Medicine

Founding Partner, Triple Board Certified – Physical Medicine & Rehabilitation; Sports Medicine; Anti-Aging, Regenerative & Functional Medicine

Dr. Matthias H. Wiederholz is cofounder of Performance Spine & Sports Medicine, LLC. He is a fellowship-trained interventional pain physician whose clinical interests include: Interventional Pain Management, Sports Medicine, Musculoskeletal Medicine, Minimally-Invasive Spine Surgery, Non-Surgical Orthopedics, and Anti-Aging / Functional Medicine.

He received his specialty training in Physical Medicine and Rehabilitation at Baylor College of Medicine in Houston, Texas where he served as chief resident. He completed fellowship training in Interventional Pain Management in Marietta, Georgia. He is board-certified in Physical Medicine & Rehabilitation and Sports Medicine. He also received advanced fellowship training through the American Academy of Anti-Aging Medicine and is board-certified in Anti-Aging, Regenerative & Functional Medicine.

Dr. Wiederholz performs a myriad of interventional pain procedures including, but not limited to the following: epidural steroid injections, facet joint injections, radiofrequency ablation, sacroiliac joint injections, discography, percutaneous disc decompression, epidural lysis of adhesions spinal cord stimulator implants, and minimally-invasive discectomies. Endoscopic spine surgery is a very unique and valuable tool in his armamentarium and makes Dr. Wiederholz one of the most specialized physicians in the field of Pain Medicine.

Dr. Wiederholz uses musculoskeletal ultrasound in the diagnosis of musculoskeletal injuries. He incorporates ultrasound for precise injection therapy including cortisone injections, prolotherapy, and PRP (platelet rich plasma). This technology is also utilized to perform the Tenex procedure, a percutaneous procedure for treating chronic tendon pain (tennis elbow, rotator cuff, plantar fasciitis, etc).

Dr. Wiederholz is the fellowship director for the sports and spine fellowship at Performance Spine & Sports Medicine. Dr. Wiederholz holds an affiliation with Capital Health System and JFK Johnson Rehabilitation Institute.

Being advanced fellowship trained in Anti-Aging, Regenerative & Functional Medicine means that Dr. Wiederholz has the most advanced training in Anti-Aging Medicine available. He is a leading expert in Bio-Identical Hormone Restoration and helps patients achieve wellness through nutrition, lifestyle, and hormone therapies.

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Michael Wolff, M.D. - Southwest Spine & Sports