Modern imaging like MRI and CT scans have transformed medicine. They allow doctors to see inside the body in incredible detail and often help guide diagnosis and treatment.

But imaging has a limitation that many patients don’t realize:

A scan does not always tell the whole story.

Every week in clinic we see two types of patients who fall through the cracks of the healthcare system:

• The under-served patient, whose serious issue is overlooked or dismissed

• The over-served patient, whose mild imaging findings lead to excessive treatment

Ironically, both patients often arrive at the same place—still searching for answers.

This week alone, we saw both.

Case 1: When a Serious Problem Is Overlooked

One patient came into the clinic after nearly two years of worsening symptoms.

They were experiencing:

• Cervical radiculopathy (nerve pain from the neck)

• Audible “clunking” with neck movement

• Difficulty swallowing (dysphagia)

• A persistent feeling of fullness in the throat

• Hoarseness of the voice

The patient also had a history of cervical fusion surgery (ACDF) performed 13 years earlier.

An MRI had already been performed and showed a ventral osteophyte (bone spur) at the C4–C5 level. However, the finding was dismissed after the patient was told the bone spur could not be affecting the esophagus.

Because of the swallowing symptoms, the patient was instead sent for:

• A barium swallow study

• An EMG, which confirmed nerve conduction abnormalities

Eventually the patient was referred to a pain management specialist, who ultimately told them there was little they could offer and referred them to physical therapy.

By the time the patient arrived in our clinic, their symptoms were still progressing.

During the evaluation, the clinical picture suggested something important: the imaging that had been performed may not have been the right imaging to fully evaluate the problem.

This can happen especially in patients with prior surgical hardware. Titanium implants can distort MRI images, making it difficult to clearly visualize surrounding structures.

After ruling out other causes of the throat symptoms with soft tissue evaluation, we recommended a cervical CT scan with soft tissue imaging.

The CT scan revealed the missing piece.

The ventral osteophyte at C4 was compressing and partially occluding the esophagus, explaining the swallowing difficulty and throat symptoms. In addition, the scan revealed severe degeneration and spinal stenosis at T1, adjacent to the previous fusion.

The next step for this patient is surgical treatment to relieve the structural compression.

In this case, the problem had been present all along—but the earlier imaging had not provided a clear enough picture to connect the dots.

Case 2: When Imaging Leads to Too Much Treatment

Another patient seen this week had been struggling with diffuse lower back pain.

Their MRI showed several findings including:

• Schmorl’s nodes at T12, L2, and L3

• Mild spinal stenosis at L4

• Mild degenerative changes at L5–S1

These findings are actually very common on spinal imaging, particularly as we age.

However, once the imaging report highlighted these changes, treatment became focused on those specific spinal levels.

The patient eventually underwent:

• Two steroid injections targeting L3–L5

• Bilateral nerve ablations at those same levels three months later

Despite these procedures, the patient’s pain persisted.

When we evaluated the patient in our clinic, the physical examination revealed a different picture.

The patient demonstrated:

• Limited hip mobility

• Tight hamstrings

• Weakness in the core and pelvic floor muscles

• Poor lifting and movement mechanics

These biomechanical patterns can place excessive strain on the lower back and create compensatory movement patterns that lead to chronic pain.

In this case, the imaging findings were likely incidental age-related changes, while the primary driver of the pain was inefficient movement mechanics and muscular imbalance.

Treatment is now focused on:

• Retraining proper lifting mechanics

• Strengthening the core and pelvic floor (yes, men need pelvic floor strength too)

• Improving hip mobility

• Educating the patient that imaging findings do not always equal the source of pain

The goal is to correct the mechanical problem rather than continuing to treat the spine directly.

Why MRI and Imaging Findings Don’t Always Equal Pain

Many patients assume that if something appears on an MRI, it must be the cause of their symptoms.

But research shows that many imaging findings are common in people who have no pain at all.

Studies have found that people without symptoms often show:

• Disc bulges

• Degenerative changes

• Spinal stenosis

• Joint irregularities

At the same time, patients can experience significant dysfunction even when imaging appears relatively normal.

This is why good musculoskeletal care requires more than simply reviewing a scan.

It requires evaluating:

• Movement patterns

• Biomechanics

• Muscle strength and balance

• Lifestyle and activity patterns

• The full clinical history

Treating the Patient, Not Just the Scan

The best outcomes occur when imaging findings are interpreted alongside a thorough clinical evaluation.

Not every abnormal scan requires aggressive treatment.

And not every patient with “normal imaging” should be dismissed.

Real healthcare happens in the space between those two extremes.

At our clinic, our goal is simple:

Treat the patient—not just the picture.

Because the most important question isn’t:

"What does the MRI say?"

The real question is:

“What is actually causing this person’s problem—and what will help them get better?”