One of the more counterintuitive findings in spine medicine, and one I spent a career watching play out, is this: if you take people with no back pain at all and image their spines, a large fraction of them have findings that look alarming on paper.
Disc degeneration, disc bulges, and disc protrusions appear commonly in people who feel completely fine, and their prevalence climbs steadily with age. By the later decades, degenerative changes on imaging are closer to normal than abnormal.
Why this matters enormously
If a finding is common in people without symptoms, then finding it in a person with symptoms doesn't automatically explain those symptoms. The scan tells you what the anatomy looks like. It doesn't tell you what hurts.
This is not an argument against imaging. Imaging is essential when there are neurological deficits, red flag symptoms, trauma, or when a surgical decision is being made. It's an argument against treating an image as a diagnosis on its own.
The harm of over-interpreting a scan
There's a well-documented phenomenon where patients told they have "degenerative disc disease" or a "bulging disc" become more fearful, move less, and do worse, independent of what their anatomy actually is. The language of the report becomes part of the problem.
"Degenerative disc disease" is a particularly unfortunate term. For most people it describes an expected age-related change, closer to grey hair than to a disease process. But it doesn't sound that way when you read it about yourself.
The scan describes the anatomy. It doesn't diagnose the pain. Those are different questions.
What actually predicts outcomes
Across the literature, the factors that best predict how someone with back pain does over time are often not the imaging findings. They include activity level, sleep quality, psychological factors including fear of movement, and general health status. That's uncomfortable for a field organized around anatomy, but it's what the data shows.
This is also why the same MRI finding can be devastating for one person and irrelevant for another. The finding isn't the whole system.
How I'd think about a decision
Surgery has a clear and valuable role. When there's genuine nerve compression producing progressive weakness, when conservative management has genuinely been tried and failed, when the clinical picture and the imaging actually correspond, the results can be excellent. I spent a career doing those operations and I believe in them.
The problem arises when a scan finding drives a decision that the clinical picture doesn't support. The question worth asking any surgeon is not "what does my MRI show" but "how does what my MRI shows explain the specific symptoms I actually have." If the answer is vague, that's information.
The general principle
Better technology gives you more data, not automatically better decisions. An MRI is an extraordinary tool that produces a great deal of true information, much of which is not relevant to why a particular person hurts. Judgment is the part that can't be imaged.
This is educational information rather than guidance about your own situation. Anyone dealing with back pain should be working through it with their own physician, who can actually correlate a scan with an exam.