What does my MRI report say?

A radiology report is not written for patients. It is a message from one specialist to another, written in a language designed for precision rather than clarity. When you read it for the first time, almost every sentence sounds alarming. This page translates the terms that appear in it most often.

A report describes what your spine looks like. It does not describe why you are in pain. These two questions are not the same, and they are confused surprisingly often.

Why almost every report shows changes

The most important number first. A large review analysed MRI scans of people who had no back pain. Among 20-year-olds, around a third already showed disc degeneration; among 80-year-olds, almost all did. A disc bulge was found in 30 out of 100 symptom-free 20-year-olds and in 84 out of 100 symptom-free 80-year-olds.

This means: the changes in your report are very likely also present in people who feel nothing at all. They are part of normal ageing, like grey hair. Whether they are the cause of your symptoms in your case only becomes clear once the scan matches what you describe and what the examination shows.

This is why the German National Disease Management Guideline on low back pain expressly advises against taking any images at all for back pain without warning signs. A report that was not needed can trigger worries that were not there before.

How a report is structured

1. Clinical question (Fragestellung)Why was the scan done? This sentence comes from the referring practice, not from the radiologist.
2. Technique (Technik)Which scanner, which imaging planes, with or without contrast agent. Rarely important for you — but it is for the practice treating you, because it shows what the scan can and cannot reveal.
3. Findings (Befund)The actual description, level by level. This is where the terms from the glossary below appear.
4. Assessment (Beurteilung)The summary in a few sentences. If you are short of time, read this section.

The level labels: L4/5, C5/6, Th12

The spine is numbered from top to bottom in three sections. C stands for the cervical spine (neck, C1 to C7), Th or BWK for the thoracic spine (mid-back, Th1 to Th12), L for the lumbar spine (lower back, L1 to L5). Below that comes the sacrum, S1 to S5.

Two numbers separated by a slash denote the disc space between them. L5/S1 is therefore the lowest disc of the lumbar spine, directly above the sacrum. It and its neighbour L4/5 carry most of the weight and are by far the most common level for a herniated disc.

The level predicts where you will feel it. A herniation at L5/S1 typically presses on the S1 nerve root and causes symptoms down the back of the leg as far as the sole of the foot. A herniation at C6/7 affects the C7 root and causes symptoms in the arm as far as the middle finger. If the level in the report does not match where you feel something, that is an important clue — usually that the change on the scan is not the cause.

Glossary

The disc

• Chondrosis, osteochondrosis (Chondrose, Osteochondrose) — wear of the disc; in osteochondrosis, also of the adjacent vertebral endplates. An ageing finding, not a disease in its own right.
• Loss of disc height (Höhenminderung) — the disc has become flatter because it has lost water. Found in almost everyone from middle age onwards.
• Bulging, disc bulge (Bulging, Vorwölbung) — the disc bulges evenly around its entire circumference. Not a herniation.
• Protrusion (Protrusion) — a localised bulge in which the base is wider than the part that protrudes. The outer fibrous ring has not yet torn all the way through.
• Extrusion (Extrusion) — what is commonly called a “slipped disc” or herniated disc: tissue passes through the fibrous ring, and the part that has emerged is wider or taller than its base.
• Sequestration, free fragment (Sequester) — a detached piece of disc tissue with no connection to the disc. Sounds the worst, but often has the best prospect of resolving: the body frequently breaks down free tissue by itself.
• Annular tear, annular fissure, HIZ (Anulus-Riss, anuläre Fissur, HIZ) — a tear in the outer fibrous ring. Also occurs in people without symptoms.

Position within the canal

• Median, paramedian (median, paramedian) — central, or slightly to one side of the centre.
• Subarticular, lateral recess (subartikulär, lateral im Recessus) — in the side niche through which the nerve root runs. Here a small amount of tissue is enough to cause marked symptoms.
• Foraminal, extraforaminal (foraminal, extraforaminal) — in or outside the opening through which the nerve exits.
• Touching, compressing, displacing the root (tangiert, bedrängt, verlagert die Wurzel) — an escalation in three steps: touches, presses, shifts. “Bedrängt” (compressing) is the wording most likely to go with symptoms.

Bones and joints

• Spondylarthrosis, facet joint arthrosis (Spondylarthrose, Facettengelenksarthrose) — wear of the small vertebral joints at the back. Two words for the same thing.
• Spondylophytes, osteophytes, bone spurs (Spondylophyten, Osteophyten, Randzacken) — bony outgrowths at the edges of the vertebrae. The body’s attempt to stiffen a mobile segment.
• Modic changes type I to III (Modic-Zeichen I bis III) — signal changes in the vertebral endplates next to a worn disc. Type I is considered active, types II and III healed or fatty.
• Spondylolisthesis, vertebral slippage (Spondylolisthesis, Wirbelgleiten) — one vertebra has shifted relative to the one below it. The degree is usually graded in four stages according to Meyerding.
• Ligamentum flavum hypertrophy (Ligamentum-flavum-Hypertrophie) — the yellow ligament in the spinal canal is thickened. A frequent contributor to narrowing.
• Baastrup’s sign (Baastrup-Phänomen) — adjacent spinous processes touch each other. Usually an incidental finding.

Narrowing

• Spinal canal stenosis (Spinalkanalstenose) — the spinal canal, through which the nerves run, is narrowed.
• Foraminal stenosis (Neuroforamenstenose) — the side opening through which a single nerve root exits is narrowed.
• Lateral recess stenosis (Recessusstenose) — the side niche within the canal is narrowed.
• Cord compression, myelopathy signal (Myelonkompression, Myelopathiesignal) — the spinal cord itself is compressed or shows a signal change. This term is more serious than the others and should be assessed by a doctor promptly.

Phrases that are more harmless than they sound

• “Marked degenerative changes” (“Deutliche degenerative Veränderungen”) — describes the extent of wear on the scan, not the extent of your symptoms.
• “Cannot be ruled out with certainty” (“Nicht sicher auszuschließen”) — radiological caution. It usually means: unlikely, but the scan cannot settle it conclusively.
• “No evidence of …” (“Kein Anhalt für …”) — good news. There is no sign of the thing mentioned.
• “Clinical correlation recommended” (“Korrelation mit der Klinik empfohlen”) — the most important sentence in the whole report. It means: the scan alone is not enough; now an examination is needed.

What a report does not contain

It says nothing about how much you are suffering. No prognosis. No treatment recommendation. And above all, no answer to the question of whether an operation is necessary. That decision is never made at the screen, but in conversation and after a physical examination — strength, sensation, reflexes, mobility.

If you would like to discuss your report with us

Bring the scans themselves, not just the written report. Your radiology practice will give you the images on a CD or other storage medium on request. We look at the cross-sectional images together, put the terms into perspective and tell you which of them fit your symptoms and which do not.