Low back pain is one of the most common reasons for an outpatient visit. The evaluation for low back pain should include a complete, focused medical history . Incidental imaging findings in lumbar MRI are common and may lead to further tests or investigations .
General radiologists frequently report lumbar MRI and they should be aware and familiar with any extra spinal abnormalities either for their clinical significance, medico legality, or for improving our practice as these findings are not uncommon. So, it is generally recommended to have a systematic reporting approach to avoid missing any finding.
We aimed to highlight some of the detected extra spinal pathologies to avoid tunnel view to lumbar MRI; we assessed the prevalence, organ of origin, suspected diagnosis, and correlation with patient symptomatology and level of threat of the detected abnormalities.
In our study, the extra spinal findings were detected in 22.5% of cases submitted to lumbar MRI for low back pain. Sedat et al.  reported a prevalence of 19.8% incidental extra spinal findings in routine lumbar MRI, and they stated that their rate is less than the values reported in the literature. Lee et al.  reported a rate of 40.5% of incidental extra spinal findings in lumbar MRI. This variability may be attributed to technical factors, like FOV, coverage, and using PACS for interpretation.
Our study included more females than males (82%), in agreement with the literature. The majority (44.5%) of our findings were ovarian in origin followed by uterine pathologies, in comparison to Sedat et al.  where most of the findings are renal in origin, and they focused more about size criteria of the detected renal cyst. Forty-one percent of our patients had ovarian cysts, either simple, complicated, or dermoid cysts. The simple cysts represent most of the ovarian lesions; they displayed homogenous hypointensity on T1WI and hyperintensity on T2WI with no wall thickening. Renal cysts account for 17% of our findings.
Complex cysts are mostly hemorrhagic; they are bright on T1WI indicating either fat or blood content, on sat suppressed T1WI; and they remain bright, ruling out a fatty lesion. If the contrast is given, there will be no enhancement .
Twenty percent of cases had uterine myomas, being the most common are benign gynecologic tumors. They primarily affect women of reproductive age, and the estimated incidence of fibroids is over 70% by 50 years of age . Although submucosal leiomyomas are the least common, they are most commonly symptomatic, and also, pedunculated subserous leiomyomas may undergo torsion, which results in infarction accompanied by pain .
We had 10 cases (10%) of osseous metastasis. Indeed, bone is the third most common organ affected by metastasis, surpassed only by the lungs and liver . Approximately 70% of patients with breast or prostate cancer have bone metastases .
Ju Fu et al.  focused on the incidental extra spinal malignancies found on lumbar MRI, the majority of their cases were lymph nodes, they reported 32.1% of their study population as lymphadenopathy either metastases or lymphoma, and our study included only three cases of lymph nodes suspected of metastases (3% of the total population).
Three out of 90 cases (3%) showed an abdominal aortic aneurysm. Abdominal aortic aneurysms occur most commonly in individuals between 65 and 75 years of age. They often do not cause any symptoms and are found incidentally on physical examination or imaging examinations of the abdomen and pelvis . Approximately 90% of all abdominal aortic aneurysms are infrarenal .
Seven out of 90 cases (8%) found to have hip lesions, namely femoral head avascular necrosis and acetabular fracture. The incidence of AVN has been increasing. The causes include greater use of exogenous steroids and an increase in trauma . MRI signs include subchondral edema, low signal serpiginous line, and double line sign (inner bright line from granulation tissue and outer dark line from sclerotic bone) on T2-weighted images [15, 16].
Clinician/radiologist feedback was very crucial as the radiological opinion guided the clinician to further assessment and the radiologists got a short and long feedback from the clinician following the patient.
We had some limitations including the inability to do all requested examinations in the same place, and the study being retrospective did not facilitate on time complementary ultrasound correlation.
We found that MRI of the lumbar spine could convey a lot of information apart from just spine imaging, and lumbar MRI alone could be reliable in some extra spinal pathologies, could raise doubt in some other, and even warn against life-threatening or serious pathologies.