How to Read Your MRI Report: Bulge, Protrusion, Stenosis & More

How is a spine MRI report organized?

A short history, the technique, the findings level by level, and an impression that summarizes what matters most.

Clinical history: why the scan was ordered.
Technique: which images were taken, and whether contrast was used.
Findings: alignment, bone marrow, the spinal cord or nerve roots, then each disc level, for example "L4-L5: broad-based disc bulge with mild bilateral foraminal narrowing."
Impression: the radiologist's summary. Start here, then read the findings for detail.

Levels are named for the vertebrae on either side of a disc: C for neck (cervical), T for mid-back (thoracic), L for low back (lumbar) and S for the sacrum. The two lowest lumbar levels, L4-L5 and L5-S1, are common sites of low back disc problems, which most often occur in the lumbar spine (AAOS).

What do the common terms mean?

Here are the terms you're most likely to see, in plain language. Disc shape terms follow the standard radiology nomenclature (Fardon et al., 2014).

Term	What it means
Disc bulge	Disc tissue extending past the normal edge over a broad area (more than a quarter of the disc's circumference). Very common with age.
Protrusion	A focal herniation where the base of the displaced disc material is wider than how far it sticks out. See protrusion vs. extrusion.
Extrusion	A herniation where the displaced material is wider than its base, or extends up or down past the disc space.
Sequestration	An extruded fragment that has separated from the disc.
Annular fissure (tear)	A crack in the outer ring of the disc. Often painless. See annular tear.
Desiccation	The disc has lost water and looks darker on certain images. Part of normal aging.
Loss of disc height	The disc is thinner than normal, often with degeneration.
Degenerative disc disease / spondylosis	General wear-and-tear changes in discs and joints. See degenerative disc.
Osteophyte	A bone spur.
Facet arthropathy / hypertrophy	Arthritis or enlargement of the small joints at the back of the spine. See facet joint pain.
Central canal stenosis	Narrowing of the main canal that holds the spinal cord or nerve roots. See spinal stenosis.
Foraminal (neural foraminal) narrowing	Narrowing of the side openings where nerve roots exit.
Lateral recess stenosis	Narrowing of the gutter along the side of the canal, just before the foramen.
Nerve root impingement / contact / compression	Disc or bone is touching or pressing on a nerve root. "Contact" is milder than "compression."
Thecal sac effacement	The fluid-filled sac around the nerves is indented or flattened by something pressing on it.
Spondylolisthesis (grade)	One vertebra has slipped forward on the one below. See spondylolisthesis.
Modic changes	Changes in the bone next to a disc, seen on MRI, often linked to degeneration.
Schmorl's node	Disc material pushed up or down into the vertebra. Usually an incidental finding.

More definitions are in the spine and MRI glossary.

What do mild, moderate and severe mean?

They describe how much narrowing or compression the radiologist sees, not how much pain you should feel.

Severity grades are useful for comparing levels and tracking change over time. But people with "severe" findings can feel fine, and people with "mild" findings can hurt a lot. The match between the finding and your symptoms is what counts.

Which findings usually matter, and which usually don't?

Findings on the same side and level as your symptoms matter most. Widespread age-related changes usually matter least.

Often more meaningful	Often incidental
Nerve root compression that matches the leg or arm with symptoms	Mild bulges at several levels
Moderate or severe stenosis with walking-related leg symptoms	Disc desiccation and mild height loss
Cord compression in the neck with hand or balance problems	Small annular fissures without other findings
Anything the radiologist flags as needing follow-up	Schmorl's nodes, mild facet arthritis

MedlinePlus notes that MRI picks up changes that aren't the cause of your current pain, which can lead to more tests, more worry and treatment you don't need. If anything on your report says "recommend follow-up" or mentions a mass, infection, fracture or cord signal change, talk with the doctor who ordered the scan promptly.

What should I bring to an MRI review?

The written report, the images if you can get them, and notes on where your symptoms are.

The radiology report (ask the imaging center or check your patient portal).
The images on a disc or a portal link, if available.
A simple drawing of where you feel pain, numbness or tingling.
Any older scans, so changes can be compared.

Dr. Gordon Stapel, DC offers a free MRI review at Springville Disc Center at Stapel Family Chiropractic in Springville. Call (801) 491-8688.

MRI report FAQs

What does "disc bulge" mean on an MRI?

The disc extends a little beyond its normal edge over a broad area, usually more than a quarter of its circumference. Bulges are very common with age and often cause no symptoms (Fardon et al.; MedlinePlus).

What does "foraminal narrowing" mean?

The foramen is the opening on each side of the spine where a nerve root exits. Narrowing means that opening is smaller, often from disc height loss, bone spurs or joint arthritis. It matters most if it matches your arm or leg symptoms.

What does L4-L5 or L5-S1 mean?

They name the disc between two vertebrae: L4 and L5 are the fourth and fifth lumbar vertebrae, and S1 is the top of the sacrum. These two lowest levels are common sites of low back disc problems.

Is an abnormal MRI a reason to worry?

Not by itself. MRI often shows age-related changes in people without pain, and those findings can cause worry and unnecessary treatment (MedlinePlus). What matters is whether findings match your symptoms and exam.

Can someone explain my MRI to me for free?

Springville Disc Center offers a free MRI review with Dr. Gordon Stapel, DC. Bring the report and, if you have it, the images on a disc or a portal login.

Talk with Dr. Stapel about your pain

Call the office or request a free consultation. You'll talk through your symptoms and history, and you'll get an honest answer about whether spinal decompression is worth considering for you.

Call (801) 491-8688 Request a Free Consultation

The consultation is free, with no obligation to start treatment. Have an MRI? Ask about the free MRI review.

Sources

This website is operated for Stapel Family Chiropractic (Springville Disc Center) in Springville, Utah. Care is provided by Dr. Gordon Stapel, DC, a licensed chiropractic physician. About this site.