Researchers followed 561 young adults with low back pain from the Spine Centre of Southern Denmark over four years. Participants underwent MRI scans of the entire spine and completed questionnaires on back-related disability at both baseline and follow-up.
The results showed that patients who developed new or more pronounced structural changes in the spine experienced less improvement in their functional status than patients whose MRI findings did not progress.
When the entire spine is followed over time, the pattern becomes clearer
Previous research has primarily focused on the lumbar spine and individual MRI findings, such as disc degeneration or disc herniation. The new study differs by examining the entire spine—from the cervical to the lumbar region—and by analysing how structural changes evolve over time.
The researchers recorded findings including disc degeneration, disc herniation, and vertebral endplate signal changes. Over the four-year follow-up period, 72 percent of participants developed new or worsening MRI findings in one or more regions of the spine.
A central finding was that the analyses showed a dose-response-like pattern: the greater the overall progression of MRI findings - measured as the number and severity of new or worsening findings across the entire spine - the less improvement patients experienced. Unlike many previous cross-sectional studies, this study followed both MRI findings and disability over time. It can therefore better illuminate whether new or worsening structural changes in the spine may be part of the explanation for how patients’ development over time.
Not the Full Explanation for Back Pain
The researchers emphasize, however, that the observed associations were relatively modest. MRI findings alone cannot fully explain why some individuals experience persistent back pain or disability, and the results cannot be used to interpret the significance of MRI findings directly in an individual patient.
Back pain is a complex condition influenced by biological, psychological, and social factors. Nevertheless, the study suggests that structural changes in the spine are not merely incidental findings but may contribute to disability over time.
Need for Further Research
According to the authors, additional large-scale longitudinal studies are needed to clarify how MRI-findings are associated with the development of back pain and whether and how this knowledge can be applied in clinical practice.
The study is based on data from the Danish Spines of Southern Denmark cohort and is the first to investigate the relationship between progression of MRI findings across the entire spine and changes in disability over time.
Bodil Al-Mashhadi Arnbak, Rikke Krüger Jensen, Mark Hancock, Tue Secher Jensen. Progression of Spinal MRI Findings Predicts Change in Disability in Young Adults With Back Pain. Spine 2026.
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