There’s a particular kind of evening that follows a scan result landing on the doormat.
You read the report. It uses words like degeneration, desiccation, bulging, fissure and arthropathy. None of them sound good. You put “L4/5 disc protrusion” into Google, and forty minutes later you’ve concluded your spine is crumbling and you should probably stop lifting your grandchildren.
We see people in this state in Walsall regularly, and the conversation that helps most isn’t reassurance. It’s translation. So here’s what those words actually mean, and — just as importantly — how common they are in people whose backs don’t hurt at all.
Start with the number that reframes everything
In 2015, researchers pooled imaging studies of more than 3,000 people who had no back pain whatsoever and looked at what their spines showed.
Among symptom-free 20-year-olds, 37% had disc degeneration and 30% had a disc bulge. By age 50, that was 80% with degeneration and 60% with a bulge. By 80, disc degeneration was present in 96% of people with no pain at all.
Read that again, because it’s the context for everything below. These findings are not a diagnosis of the cause of your pain. They are, in large part, a description of a spine that has been used.
That doesn’t mean scans are useless — we’ll come to when they genuinely matter. It means a report describing what your back looks like is a different document from an explanation of why it hurts, and the two are constantly confused.
The glossary
“Degenerative changes” / “degenerative disc disease”
Despite the name, this isn’t a disease in any conventional sense. It’s the radiologist’s term for the normal age-related changes discs undergo — much like the term “grey hair” describes a change without implying illness.
It is present in the majority of middle-aged spines, including a great many that have never caused a day’s trouble.
“Disc desiccation” / “loss of disc signal”
Discs are largely water when we’re young, and they gradually hold less of it with age. On an MRI, water shows bright; a drier disc shows darker. That darkening is desiccation.
Among pain-free people, it’s found in roughly 17% of 20-year-olds and 86% of 80-year-olds. It is close to a universal feature of the ageing spine.
“Disc bulge”
A bulge means the disc extends slightly beyond its normal boundary around most of its circumference — think of a tyre under load rather than something torn or burst.
It’s one of the most alarming-sounding terms on any report and one of the most common findings in people with no symptoms.
“Protrusion”, “extrusion” and “sequestration”
These describe herniations, and radiologists use them precisely, in ascending order:
- Protrusion — a focal push outward where the base is wider than the part that’s protruding.
- Extrusion — the material extends further, so the outer part is wider than its base.
- Sequestration — a fragment has separated from the disc entirely.
These are more meaningful than a bulge, particularly when there’s leg pain matching the level involved. They still don’t automatically require surgery. A large proportion of disc herniations reduce in size over months without any operation, and symptoms frequently settle before the imaging does.
“Annular fissure” (sometimes still written as “annular tear”)
The word “tear” has done enormous damage here, which is why “fissure” is now the preferred term.
It describes a small split in the outer layers of the disc. It does not imply an injury, an accident, or something that will worsen if you move. Fissures appear in around 19% of pain-free 20-year-olds.
“Facet arthropathy” / “facet joint degeneration”
The facet joints are the small paired joints at the back of each spinal segment. Arthropathy simply means arthritic change in them — the same process that shows in knees and hands.
In pain-free people it’s found in roughly 4% at age 20 and 83% at age 80.
“Modic changes”
These describe signal changes in the bone immediately adjacent to a disc, graded Type I to Type III. Type I has attracted the most research interest as a possible pain generator, but the evidence is mixed and the finding is far from a definitive explanation.
“Spondylosis”
A broad umbrella term for degenerative change in the spine generally. It tells you the spine has aged. It doesn’t localise a problem.
“Spondylolisthesis”
One vertebra has shifted forward relative to the one below, graded by severity. It sounds dramatic and occasionally matters a great deal — but low-grade slips are found in around 3% of pain-free 20-year-olds and 23% of pain-free 80-year-olds, often entirely stable and entirely silent.
“Schmorl’s nodes”
Disc material pressing into the bony surface above or below. Usually a longstanding, incidental finding of no clinical consequence.
“Loss of / straightening of the lumbar lordosis”
Your lower back’s usual inward curve looks flatter than expected. This is very often a consequence of lying still in a scanner while your muscles guard a painful area — a snapshot of that moment rather than a structural fact about you.
“Canal stenosis”, “foraminal narrowing”, “nerve root contact”
These describe narrowing of the spaces the spinal cord and nerves travel through. The language is graded deliberately: contact or abutment means a structure is touching a nerve; compression means it’s being squashed. They are not the same thing, and touching a nerve does not necessarily hurt.
Stenosis becomes clinically significant when the picture matches the symptoms — classically leg pain and heaviness on walking that eases when you sit or lean forwards.
So when does a scan genuinely matter?
It would be an overcorrection to conclude that imaging never counts. It does, in three situations.
When the findings match the clinical picture. An extrusion at L5/S1 in someone with pain, numbness and weakness following exactly that nerve’s distribution is meaningful information, not background noise.
When surgery is being planned. No surgeon operates without knowing precisely what’s there.
When something needs excluding. Fracture, infection, inflammatory disease and, rarely, tumour all require imaging to identify. This is why guidelines don’t say “never scan” — they say don’t scan routinely, because scanning everyone produces a great deal of incidental findings and a great deal of unnecessary fear.
The two reports that look identical
A useful way to hold all of this: imagine two people in their fifties whose lumbar MRIs are, to a radiologist, essentially indistinguishable. Same degenerative changes at two levels, same modest bulge, same facet wear.
One is a keen gardener who has never had more than a passing twinge. The other has been off work for four months and no longer bends to load the dishwasher.
The scans cannot tell those two people apart. Nothing in the imaging explains why one is fine and one is not — which is precisely why the scan can’t be the thing that determines what happens next. What separates them lies in strength, movement confidence, sleep, stress, what they’ve stopped doing, and what they’ve been told about their spine.
All of those are things that can be changed. None of them appear on a report.
Why the wording matters more than people realise
There’s a reason clinicians have become careful with this language.
Being told your spine is degenerating, crumbling or worn out changes behaviour. People stop bending. They stop lifting. They avoid exercise, brace their trunk constantly, and give up activities they enjoyed — all rational responses to being told a structure is failing, and all things that tend to make backs stiffer, weaker and more painful over time.
The words on a report are descriptive. What people do in response to those words is where much of the real damage happens.
What to do with your report
Bring it to someone who will go through it with you alongside an actual examination.
A report on its own answers almost nothing useful. What answers something useful is the combination: what your symptoms are, what movements reproduce or ease them, how your strength and nerve function test out, what you’ve been avoiding, and whether the scan findings line up with any of it.
Very often the outcome of that conversation is considerably less alarming than the forty minutes you spent on Google — and the plan that follows is more about restoring confident movement than protecting a fragile structure.
Bring your scan report in
If you’re sitting on an MRI report you don’t understand, or you’ve been told something about your spine that has left you frightened to move, we’d like to help you make sense of it.
Back Pain Expert Walsall, delivered by Back2Fitness Physiotherapy, offers a free discovery visit — no cost, no obligation, no referral needed.
Bring the report. We’ll go through what it says, examine you properly, and give you an honest view of what’s relevant to your situation and what’s simply a description of a spine that’s been in use for a few decades.
Get in touch today to book your free discovery visit.