Mild, moderate and severe on an MRI report are the radiologist’s best guess at how much. They are useful. But they rest more on opinion than they seem to.
In more detail
- For most spine findings, there is no agreed cutoff that separates mild from moderate from severe. Different radiologists grade the same scan in different ways.
- The grade describes anatomy. It does not describe your pain, what you can do, or how you will do.
- This is why a report reading ‘severe’ can belong to someone walking comfortably, and ‘mild’ to someone barely coping.
What it means for you
Use the grade as one piece of information among several. What decides treatment is whether the graded finding sits at the level and side that match your symptoms and your exam.
Remember the general rule. Findings like this one are common in people with no pain at all. They become more common with age. A finding on a report is not a diagnosis until someone has matched it to your symptoms and your exam. See understanding your MRI report.
Bring your scan and report in and we will go through it with you. Call us or request an appointment.
How common is it, and what does it predict?
These grades describe how the anatomy looks, not how bad your symptoms are. The two do not line up well. Severe degenerative change often shows up in people with no pain at all. Mild change sometimes comes with heavy pain when a nerve root happens to be irritated. Radiologists also do not all grade the same way, though patients assume they do. One reader’s moderate is another’s mild. The useful way to read a report is to see which structures are involved and at which levels. Then match that to where your symptoms actually are.
Common questions
My report says severe. Should I be worried?
Not because of the word alone. Bring the scan in and we will tell you whether that finding explains what you feel.
The mechanism is covered in Understanding Your MRI Report.
Should I get a second scan?
Rarely useful by itself. A second opinion on what your current scan means is usually worth more than a new image.
Does a worse grade mean I need surgery?
No. Surgery decisions rest on symptoms, exam findings and how you respond to treatment. They do not rest on one word in a radiology report.
That is the subject of Spinal Canal Stenosis.
Sources
- Brinjikji W et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 2015. PubMed 25430861
- Fardon DF et al. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. The spine journal : official journal of the North American Spine Society, 2014. PubMed 24768732
- Bezuglov E et al. Asymptomatic Degenerative Changes in the Lumbar Spine Among Professional Soccer Players. Spine, 2021. PubMed 33347092
- Banerjee A et al. The Prevalence of Degenerative Cervical Myelopathy-Related Pathologies on Magnetic Resonance Imaging in Healthy/Asymptomatic Individuals: A Meta-Analysis of Published Studies and Comparison to a Symptomatic Cohort. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2022. PubMed 35255357
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