A disc bulge or degenerative change on MRI is extremely common - studies consistently show that significant imaging findings are present in the majority of people over forty who have no pain at all. The scan finding does not determine treatment; the patient's symptoms do. What matters clinically is whether the imaging finding explains the patient's specific pattern of pain or neurological symptoms, and whether those symptoms are responding to conservative care. Surgery is indicated by symptoms and functional limitation, not by the appearance of a scan. I regularly see patients who have been told they need surgery based on an MRI report, when their symptoms are well within the range that physiotherapy and targeted treatment can address effectively.
Written by Dr. Nirdesh H J, MBBS (Bangalore Medical College and Research Institute), MS Orthopaedics (Ramaiah Medical College), DNB Orthopaedics (National Board of Education), FNB Spine Surgery (Indian Spinal Injuries Centre, New Delhi), AO Spine Asia Pacific Fellowship (Bombay Hospital, Mumbai, under Dr. Arvind Kulkarni), AO Spine International Fellowship (Kyung Hee University, Seoul, South Korea, under Prof. Yong Chan Kim), Fellowship in Minimally Invasive Spine Surgery (Germany), Consultant Orthopedic Spine Surgeon, SPARSH Hospital, HBR Layout, Hennur Road, Bengaluru 560043. Phone: +91 6363626242.
