Purpose: Magnetic resonance imaging (MRI) is the diagnostic imaging modality of choice for spinal disorders. The high prevalence of “abnormal” MRI findings within asymptomatic individuals is well established, however, referrals to spine surgeons are often based on symptomatically discordant or non-surgical MRI ‘abnormalities’. The purpose of this study was to determine the prevalence of typical spine MRI abnormalities among symptomatic surgical candidates (SC) and non-surgical (NS)patients.

Method: A retrospective cohort study was conducted on 1,585 patients (with a lumbar MRI) seen by a spine surgeon. The cohorts were compared in terms of the total amount, type, severity and number of levels of abnormalities on MRI. All patients were prospectively stratified regarding surgical candidacy.

Results: There was no difference between the cohorts (n=722-SC / 863-NS) in terms of the total amount of structural abnormalities present (p=0.26). There was no difference in the prevalence of DDD, disc-herniation or previous surgery (p> 0.2). However, there was a higher prevalence of spinal stenosis (0.513 vs. 0.394) and spondylolisthesis (0.263 vs. 0.112) within the SC (p≤0.01). Logistic-regression showed that patients with disc-herniation, stenosis or spondylolisthesis were 1.49, 1.61 and 2.84 times more likely to be SC respectively (p≤0.001). Subjects with a report of severe/large herniation or stenosis were 3.30 and 2.25 times (p< 0.001) more likely to be SC respectively. Patients with one-level anomalies were 2.19 times (p< 0.0001) more likely to be SC.

Conclusion: It is hopeful that these results will better enable non-surgeons to more effectively identify and educate patients with a higher likelihood of being surgical candidates.