Black discs on MRI scans are seen normally as age advances. The discs are the ‘soft cushions’ between the bones of the spine to absorb the weight and load during the normal activities in life.
Normal discs contain a lot of water and it acts as a sponge to absorb the shocks while walking, running, sitting, standing and working. As age advances, the discs lose water and become ‘less spongy and soft’. As they lose water, the discs appear as a ‘Black discs’ on the MRI scan. They are also called ‘degenerate discs’.
How does a Normal Disc appear on the MRI scan?
The picture shows an MRI scan of the lumbar spine with ‘normal discs’. Normal disc appears ‘white’ in colour as indicated in the picture. These discs are the ‘soft cushions’ between the bones of the lumbar spine and in young people and these discs contains a lot of water.
The water in the disc allows the discs to act like a sponge to absorb the pressure on the spine during activities of our daily living. The discs spring back into their normal shape like a kitchen sponge very quickly due to the high water content. The softness of the disc prevents wear and tear and problems like ‘disc rupture’ or ‘disc prolapse’.
What does a ‘Black Disc’ on an MRI mean?
The picture above shows an MRI scan of the lumbar spine with ‘Black discs’. It appears black in colour as indicated in the picture. As you know the discs are the ‘soft cushions’ between the bones of the lumbar spine and as age advances, the discs lose their water content gradually. Therefore the disc becomes like a ‘rubber’ and loses its softness like a sponge.
This reduces the ability of the ‘black discs’ to absorb the pressure on the spine during activities of our daily living. They are not able to discs spring back into their normal shape very quickly due to the low water content. It breaks off under the pressure and leads to problems like ‘disc rupture’ or ‘disc prolapse‘.
Are all ‘black discs’ bad for my back?
No. Not all black discs on MRI scan are bad for your back. Black discs indicate an age related process like our hair going grey and the skin getting wrinkled. These are ‘normal’ changes that happens as age advances. Some people will have a lot of black discs with no problems at all. Only some black discs cause low back pain.
Why do only some ‘black discs’ on MRI cause low back pain?
Black Discs on MRI scans have less water as the tissues inside those discs dry off as age advances. In addition to old age, heavy duty labour and a family history of low back pain, only some black discs undergo the ‘wear and tear’ changes to cause inflammation. This produces chemicals that seep into the tissues and nerves around the spine. It is these chemicals that cause low back pain from the irritation of the nerves and soft tissues.
What is Disc Degeneration?
The ‘wear and tear’ changes that occur in the black discs are called ‘disc degeneration’. As the disc has a very limited blood supply and nutrition, the wear and tear changes worsen over time. Our repeated motions of the spine from the activities of daily living also causes damage to the discs.
Repeated movements of the spine under the weight of our body causes an ‘internal disc disruption’ inside the discs. There is loss of height in the disc due to reduction in water as the discs are squeezed with our body weight. The discs ‘dry out’ and begin to appear black on MRI scans. It does not necessarily mean the discs are painful.
What is degenerative Disc disease?
Degenerative Disc Disease is the medical term for a black disc. As the disc undergoes ‘wear and tear’, it loses water. This process of wear and tear is called disc degeneration. This is not a disease but a natural development as age advances. Not all black discs on the MRI scans cause low back pain. Only a few people with black discs suffer from back pain.
What is a ‘degenerative cascade’?
Black Discs on the MRI scan are the cause of disc degeneration and they go through a degenerate cascade. First, there is an injury to the disc. This releases the chemicals into the sorrounding tissues causing low back pain. Next, the disc becomes unstable and this allows the bones of the spine to move causing frequent low back pain. Finally, the disc hardens itself and your low back pain episodes are fewer than before.
Can a ‘black disc’ go away on its own?
No, it does not. Once your disc shows signs of degeneration with a ‘black disc’ appearance on the MRI scan, it is not possible to reverse the process as the changes described above are permanent. But you can manage with small lifestyle changes. These are:
- Consider quitting smoking
- Exercise more with physiotherapy
- Maintain a healthy diet
- Medications when necessary.
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How do you manage a ‘black disc’?
Physiotherapy:
These include core strengthening exercises along with a physiotherapy programme. These are exercises here that would help you manage your back effectively.
Spine Steroid Injections:
These include Caudal Epidural injections and Nerve root injections. These has been shown to decrease the low back pain but long term benefit cannot be expected unless these injections are followed with physiotherapy. A pain management team also can help you manage the pain.
Spine Surgery:
If both the above interventions fail, then fusion surgery to join up the bones of your spine is a procedure with good results. Fusion surgery stops the movement of the spine by removing the painful disc and replacing it with a metal insert between the bones.