03/09/2026
THE MRI IS NOT THE PATIENT
An 80-year-old patient is not simply an “elderly patient.”
And an MRI showing a lumbar disc herniation is not, by itself, a diagnosis of what is generating that patient’s symptoms.
In older adults, imaging frequently shows multiple findings at the same time:
disc degeneration, facet arthropathy, foraminal stenosis, central stenosis, spondylolisthesis and disc herniation.
The clinical question therefore becomes much more interesting:
Which finding is actually relevant to this patient?
This is where clinical reasoning must come before technique.
I want to know:
Is there a neurological deficit?
Is strength changing?
What are the reflexes telling me?
Is sensation altered?
How does the patient walk?
How is balance?
What happens under load?
And, most importantly, is the clinical picture consistent with the imaging?
A systematic review by Brinjikji et al. demonstrated just how common degenerative spinal imaging findings are in asymptomatic individuals — and how dramatically their prevalence increases with age.
This is one of the principles that has strongly influenced the development of SPN – Simplified Practical Neurology:
We don’t treat an MRI.
We don’t treat an age.
We assess the individual nervous system in front of us.
And then we choose the appropriate stimulus.
📚 Reference:
Brinjikji W, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol. 2015;36:811–816. PMID: 25430861.
PubMed
Learn more about SPN – Simplified Practical Neurology:
SPN Technique
DiscHerniation HealthyAging