MRI’s… What are they good for?
Absolutely nothing! Or at least that’s what it seems when it comes to identifying what’s causing back/sciatic pain related to disc herniation identified on MRI, according to the study below.
This is not ground breaking news. Other studies have indicated similar conclusions, that, in the absence of nerve root compromise (pinching or compression of the nerve root), identifying a protruding or even extruded disc on MRI has little to no relevance to symptoms of leg pain.As one of my high school football coaches (Mark Matheny) used to say, “What’s a mother to do”?
I think what you must understand about these conclusions is that you should not “make a mountain out of a mole hill” when it comes to disc herniation findings. Some physicians will make a big deal about it and that’s just wrong.
Most, and I mean most, disc herniations can be treated successfully without surgical intervention.
We utilize two protocols to conservatively treat disc herniations. The one that works the best, in most cases, is the McKenzie protocol, and the other is Cox’s distraction protocol. The McKenzie protocol is effective for cervical disc herniations a well.
So, if you have arm or leg pain associated with a disc problem, we can likely help! If you have questions about this topic, please don’t hesitate to call and discuss the issues with me.For more information on McKenzie or Cox work, go to my website and look under disc herniation or McKenzie: http://www.greathousechiropractic.com
Magnetic Resonance Imaging in Follow-up
Assessment of Sciatica
The Hague Spine Intervention Prognostic Study Group*
N Engl J Med 2013;368:999-1007.
Copyright ˝ 2013 Massachusetts Medical Society.
One reviewer wrote: “A recent systematic review concluded that even in the acute setting of sciatica, evidence for the diagnostic accuracy of MRI is not conclusive.”
Discussion: In summary, in patients who had undergone repeated MRI 1 year after treatment for symptomatic lumbar-disk herniation, anatomical abnormalities that were visible on MRI did not distinguish patients with persistent or recurrent symptoms of sciatica from asymptomatic patients. Further research is needed to assess the value of MRI in clinical decision making for patients with persistent or recurrent sciatica.
This is bad news because the outcomes of spinal fusion are less than stellar in the first place, in fact, they’re poor.
We’ve seen the evolution of back surgery, including fusion, an attempt to stop movement in the offending joints, change 180 degrees, to the disc replacement, trying to preserve movement. Both have demonstrated limited utility in addressing back pain. There are exceptions to the rule but studies and reviews prove that the lion’s share of these procedures are ineffectual and can have significant complications.
Let’s not forget microdiscectomy, chymopapain injections, percutaneous discectomy, percutaneous laser discectomy, and percutaneous arthroscopic (endoscopic) discectomy. These procedures are touted as less invasive, which is a good thing because the other procedures leave behind a wound site that looks like a bad accident, with plenty of scar tissue to follow. Not good! The less invasive procedures did reduce iatrogenic complications, but were only successful for a “select few”! Determining who is a good candidate for the procedure was and is the problem today.
So what’s my point? The rule in healthcare as it relates to spinal surgery for back or neck pain is; exhaust all conservative forms of care first. Statistically, once this is done your surgical success outcome increases a great deal!
Also note that the outcomes for all or no procedures are about the same in about nine months to a year. So, don’t rush to surgery, there’s usually no turning back after that fails and subsequent surgery outcome stats get worse and worse.
I practice two mechanical treatment protocols for disc problems, with a good success rate I might add, and with little to no complications. Go to GreathouseChiropractic.com for more information on conservative disc treatment protocols with good success rates.
Be Kind To Your Spine
Cochrane Reviews are systematic reviews of primary research in human health care, and health policy. Internationally recognized as the highest standard in evidence-based health care.
Remember this Home Alone movie memorable quote…
“You know, Kevin, you‘re what the French call les incompetents”
More specifically, is your disc(s) incompetent? If it is, you might need back or neck surgery. If it isn’t then I can probably help you.
An incompetent disc is a disc herniation or rupture where the center gel substance (nucleus) has extruded all the way through the disc wall, like a hole in a jelly donut. In some cases the inner disc walls can be so damaged that the gel center off centers in multiple directions, incapable of re-centering. This, too, is a degenerative form of disc incompetence.
When the disc is incompetent, your conservative (nonsurgical) recovery potential reduces. The good news is most disc problems aren’t incompetent and the bulging/protrusion can be reduced and stabilized in many cases. With disc reduction, leg/arm symptoms abolish and local back and neck pain abolish as well!
Through reliable examination we can determine if the disc is competent and what kind of treatment will reduce and correct the problem. Most back/neck problems are disc related. Do not have back or neck surgery before having a McKenzie (MDT) examination!
We do McKenzie!
Recently a patient and I discussed his back problem. He has a low back disc herniation that responds well to mechanical therapy. He remarked about a friend who recently had injection therapy, which helped his radiating leg pain. He wanted to know how long that would last. Obviously nobody really knows the answer to that question, everybody is different. The patient said the injection was reportedly very painful and for that reason he would opt for laser back surgery if he had to go beyond my form of care. He explained he has discussed the issue with a few people who heard of great results with laser surgery.. As with anything else in health care, you cannot base your decision on
a survey done with just a few people. Science has statistics out there and
they aren’t that great for any form of treatment of low back or neck pain. So, the last thing you want to do is pick one of the most expensive and
one that is invasive, unless the diagnosis absolutely matches the treatment. And there in lies the problem; 85% of all back problems have no valid
or reliable diagnosis. I mentioned the lack of specificity of CT Scans
and MRI’s and the patient remarked that a local orthopedist calls MRI findings
”MRLies” because of the lack of specificity. These diagnostic studies
are very sensitive, as a matter of fact many times they reveal a
multitude of abnormalities that science can’t reliably confirm are related to your back or neck complaints. Fact: Just because a disc
herniation is present doesn’t mean that’s the cause of your problem (non-specific). Reliable studies show that a relatively high percentage of people have disc herniations but have no symptoms at all.Fact: A very high percentage of spinal disc herniations with leg or
arm symptoms respond favorably to conservative non-surgical care. With
a proper mechanical evaluation this can be ascertained quickly. A
mechanical assessment that points to a more specific diagnosis/ subgrouping has a high positive outcome prognosis. Fact: Cost for back care is astronomical in the United States,
approaching 100 billion per year but the outcomes are not getting better, they are worse! So don’t let anybody fool ya’. High tech hasn’t improved a thing in the overall
scope of things either. Unless you have progressive nerve damage or intractable pain, don’t have back surgery until you’ve exhausted conservative care. Fact: There’s much higher potential for significant adverse side affects with surgery as compared to conservative mechanical therapy.Fact: Cost…. Mechanical therapy is significantly less expensive
Disc herniations are reducible by means of mechanical therapy! Even large disc herniations! For more info on Valid & Reliable conservative back care go to my website: Website: http://greathousechiropractic.com/ Look under Disc Herniation Care. Also check out the section on McKenzie.
Jim Greathouse, D.C.