When a scan becomes the whole story

At the OM Yoga Show, a woman of 36 came to speak to me about her back. She had only been in pain for a few weeks, but after spinal imaging she had been told she had Bertolotti’s syndrome and that this was the source of her pain.

We did not try to settle the question there and then. What interested me was the question that can so easily get lost once a scan gives us a name: why has the pain appeared now?

A structural finding deserves attention. It may be part of the explanation, and it would be wrong to dismiss it. But finding something on an image is not the same as establishing that it is the cause of a person’s present pain.

The difference between a finding and a diagnosis

In this case, the distinction is particularly important. A lumbosacral transitional vertebra is a variation in how the lowest part of the spine is formed, an anatomical variation that has been present since birth. Bertolotti’s syndrome is the diagnosis given when, after clinical assessment, that variation is considered to be causing a person’s symptoms.It has been there since birth. Bertolotti’s syndrome is the name used when that variation is judged to be causing pain or other symptoms. The two terms are not interchangeable: many people with a transitional vertebra have no symptoms from it.

That does not tell us what was happening for the woman I met. I had not assessed her and cannot know whether the finding was contributing to her pain. But it does leave room for a fuller conversation. What had changed in the weeks before the pain began? Where was the pain, and what made it better or worse? Were there other possible contributors? How could the imaging result be understood alongside her history and examination, rather than in place of them?

Sometimes a visible difference is clinically significant. Sometimes it is incidental. Sometimes it is one part of a much wider picture. The task is not to decide in advance which of these must be true.

What we carry away from an explanation

This week, I read Patty Azzarello’s account in The Guardian of growing up with several spinal diagnoses. A surgeon’s warning led her to fear ordinary movement and to think of her body as fragile. A second opinion gave her a different assessment and she did not have the proposed operation, yet the fear stayed with her for years. An unexpected bike ride began to change what she believed she was capable of.

Her spinal conditions are different from the finding described to me at the show. Her story cannot tell us what another person should do. What it does show, powerfully, is that the words accompanying an image can become part of someone’s experience of their body long after the appointment ends.

We need explanations that neither frighten people unnecessarily nor brush aside their symptoms. Pain is real, whether or not a scan provides a neat answer. Equally, a meaningful finding calls for careful clinical assessment, not a glib assurance that it does not count.

Keeping the question open

My conversation at the OM Yoga Show has stayed with me because the woman’s pain was recent, while the anatomical variation she had been told about was not. That contrast does not disprove the diagnosis. It invites us to be curious about timing, context and the person in front of us.

For me, natural back care begins with that willingness to look more fully. A scan can be useful, but it is one source of information. It cannot by itself tell us everything about how a person moves, feels, lives or responds to support. Nor can it describe the body’s capacity for change.

If you have been given a spinal diagnosis and feel that it has become the whole story, you might ask your clinician: How confident are we that this finding explains my symptoms? What else did you consider? What would help me understand what has changed, and what I can safely do next?

Those questions do not reject the scan. They give it its proper place.

For more on another common source of anxiety after imaging, read Disc prolapse or bulge: understanding your MRI.

Further reading

Marchesi and colleagues, Journal of Spine Surgery (2026): review of lumbosacral transitional vertebrae and Bertolotti’s syndrome.

NHS England GIRFT: What matters to patients — a guide to chronic pain (2026).