Tests – what are they good for?
In the realm of back pain tests, of
MRIs that question must be asked. What are MRIs good
for when the proportion
of useful, influential MRI studies is so minor?
False positive MRI results upset those who get
these results. They arouse fear or caution where it
is not always warranted. MRIs like this blur the
proper treatment plan. They spend a lot of money.
Mandeville Chiropractic carefully weighs the necessity of
MRI in the Mandeville chiropractic treatment plan of Mandeville
back pain relief.
MRI interpretations by
radiologists often differ.
The true-positive finding rate was 56.4%, and the miss-rate was 43.6%. (1)
MRI imaging may cause false suspicion. When
following the guidelines of the American College of Radiology, 93% of lumbar
spine MRIs were appropriate. Of those, only 13% uncovered
anything suspicious. Of the 36 MRIs that provoked
suspicion of cancer or infection, 81% were false-positive. 59% of the follow-up
MRIs on those suspicious findings were false positives. (2) MRI imaging may misinform.
For example, MRI demonstrates that the presence of
disc degeneration in asymptomatic persons – persons with no back pain – grows
with age: 37% in 20 year olds and 96% in
80 year olds; disc bulges: 30% to 84%; disc protrusion: 29% to 43%; annular
fissures 19% to 29%. These imaging findings suggest that
these are signs of normal aging. They remind all doctors, remind chiropractors
like yours at Mandeville Chiropractic, to correlate all such
findings with patient symptoms. (1,3) Your Mandeville
chiropractor does this!
Choosing Wisely guidelines for American chiropractors recommend
not repeating spinal imaging and not obtaining spinal imaging for
patients with acute low back pain in the first 6 weeks of back pain (except when “red flags” are present– issues that indicate
something more sinister). (4) A review of the efficacy
of the Canadian Choosing Wisely recommendations for imaging nonspecific spinal
pain and symptoms stated that there is very low risk of missing
a serious cause of back pain. (5) The goal
of guidelines is less imaging, fewer false positives. Mandeville Chiropractic wants what is
best for our Mandeville chiropractic care patients.
COX® TECHNIC’S VIEW
Chiropractors like yours at Mandeville Chiropractic study
all the symptoms, tests and images our Mandeville chiropractic back
pain patients [[present on|bring with them39] their first Mandeville
chiropractic visit. So many back pain patients present to
Mandeville Chiropractic with MRI images already in-hand.
Mandeville Chiropractic will look at them but will rely more on clinical exam findings and correlate them to what the MRI shows.
A rule of thumb with the Cox Technic System of Back Pain Relief is to seek 50% decrease of back pain in the first month
of care before arranging more imaging or
testing or referring for surgical consultation. (6)
CONTACT Mandeville Chiropractic
Listen to this PODCAST
with Dr. Dan Clark on the Back Doctor’s Podcast with Dr. Michael Johnson as he describes imaging for back pain in the scheme of treatment
for pain relief.
Schedule your Mandeville chiropractic appointment
with Mandeville Chiropractic today. Let us explore together
the best path to Mandeville back pain relief – with or without MRI