A colleague shared an interesting article by Kuittinen, et al out of Finland. The authors looked at visually measured spinal stenosis on MRI and correlated it with patient symptoms. It wasn't what you might have expected.
Spinal stenosis is narrowing of the spinal canal. It's more common as we get older and can cause characteristic symptoms including pain in the legs with walking and
improvement with leaning over or sitting down. Treatment options are limited-- PT and medication don't help much. Epidurals are temporary and surgery is often ineffective.
The authors found that patients' leg pain was higher and walking distance less with moderate stenosis than severe. They found that degree of stenosis did not correlate well with functional capacity or patient symptoms.
While this study does not address psychological factors or issues, it does point out again that imaging results are not determinative for pain. In this study, patients with severe stenosis did better than moderate. There was not a 1 to 1 correlation between pain and degree of narrowing.
So I remind people of one of the basic principles of spinal/orthopedic medicine. Treat the patient, not the imaging!
Look beyond the obvious and individualize care. Consider the psychological.