By Dr. Anurag Aggarwal

Emergency Physician | Spine & Pain Specialist
Fortis Hospital Noida | Delhi NCR

Are You Treating the MRI Report or the Patient?

One of the biggest misconceptions about back pain is that every MRI showing a disc bulge is the cause of the pain.

Every week, many patients visit my clinic carrying MRI reports that mention:

• Disc bulge
• Disc prolapse
• Slip disc
• Lumbar spondylosis

They are convinced that their MRI has found the problem.

But after a detailed history and physical examination, many of these patients are actually suffering from Ankylosing Spondylitis (Axial Spondyloarthritis)—an inflammatory disease, NOT a disc problem.

याद रखें…

MRI रिपोर्ट मरीज का इलाज नहीं करती। मरीज की कहानी (History) और डॉक्टर की जांच (Clinical Examination) सही निदान करती है।

Could Your Back Pain Be Ankylosing Spondylitis?

If you are between 20–40 years of age, your back pain may not be due to a disc.

It could be Ankylosing Spondylitis (AS) or Axial Spondyloarthritis (axSpA).

Early diagnosis is extremely important because untreated disease can lead to permanent spinal stiffness and disability.

Warning Signs of Inflammatory Back Pain

Ask yourself these questions:

✔ Age below 40 years

✔ Back pain lasting more than 3 months

✔ Pain worse after resting

✔ Early morning stiffness lasting more than 30 minutes

✔ Pain improves with exercise

✔ Night pain that wakes you from sleep

✔ Alternating buttock pain

✔ Family history of Ankylosing Spondylitis

If you have several of these symptoms, you should be evaluated for inflammatory arthritis.

Why MRI Alone Can Be Misleading

Many healthy adults have disc bulges on MRI without any symptoms.

Similarly, patients with Ankylosing Spondylitis may also have age-related disc changes.

If the doctor treats only the MRI findings, the real disease may remain undiagnosed for years.

Always correlate MRI with clinical findings.

Clinical Examination is the Key

A thorough examination may reveal:

• Reduced spinal flexibility
• Limited chest expansion
• Sacroiliac joint tenderness
• Positive inflammatory back pain pattern
• Reduced lumbar movements

These clues often point towards Ankylosing Spondylitis rather than a simple disc disease.

What Tests Help Confirm the Diagnosis?

Your doctor may advise:

• X-ray of Sacroiliac joints

• MRI Sacroiliac joints (especially in early disease)

• ESR & CRP (markers of inflammation)

• HLA-B27 by PCR

Is HLA-B27 Positive in Everyone?

No.

A positive HLA-B27 supports the diagnosis but does not confirm it alone.

Many patients with Ankylosing Spondylitis can be HLA-B27 negative, while many healthy individuals can be HLA-B27 positive.

Diagnosis is always based on:

History + Clinical Examination + Imaging + Laboratory Findings

Why Early Diagnosis Matters

Without treatment, Ankylosing Spondylitis may lead to:

• Progressive spinal stiffness
• Fusion of vertebrae
• Loss of flexibility
• Chronic pain
• Reduced quality of life
• Hip involvement
• Eye inflammation (Uveitis)
• Rarely heart and lung involvement

Early treatment can significantly slow disease progression.

Treatment of Ankylosing Spondylitis

Treatment is individualized and may include:

Lifestyle

• Daily stretching
• Posture correction
• Regular exercise
• Swimming
• Smoking cessation
• Weight management

Medicines

Depending on disease severity, treatment may include:

• NSAIDs (first-line therapy)
• Disease-modifying medications in selected cases
• Biologic agents (TNF inhibitors, IL-17 inhibitors)
• JAK inhibitors in appropriate patients under specialist supervision

Physiotherapy

Regular supervised physiotherapy is one of the most important parts of treatment.

Pain Management

Interventional pain procedures may help selected patients who have persistent pain due to associated mechanical spine problems.

The Most Important Message

Do not treat the MRI report. Treat the patient.

A proper diagnosis comes from:

✔ Listening to the patient’s story

✔ Careful physical examination

✔ Correlating symptoms with X-ray or MRI

✔ Appropriate blood tests such as HLA-B27 (when indicated)

Correct diagnosis means correct treatment.

When Should You See a Spine Specialist?

Consult a specialist if you have:

• Back pain lasting more than 6 weeks
• Morning stiffness
• Pain improving with activity
• Recurrent buttock pain
• Young age with chronic back pain
• MRI findings that do not explain your symptoms
• Persistent pain despite treatment

Early evaluation can prevent years of suffering.

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About Dr. Anurag Aggarwal

Dr. Anurag Aggarwal is an Emergency Physician, Spine & Pain Specialist with expertise in diagnosing complex causes of back pain, including disc disorders, inflammatory spine diseases, nerve pain, sciatica, sacroiliac joint disorders, and minimally invasive pain interventions.

He believes that accurate clinical diagnosis is more important than treating MRI reports alone.