The common pathway for individuals with low back or neck pain is to get an MRI, be referred for surgical referral, receive spinal injections and then surgery. This article reminds you that this pathway leaves out conservative, non surgical options that are cost effective.
The article “Patterns of Care After Magnetic Resonance Imaging of the Spine in Primary Care SPINE Volume 38, Number 1, pp 51–59 2012” reviews whether or not an MRI indicating degenerative disk disease, stenosis or herniation will lead to spine surgery. That is because spinal MRI is considered the “gold standard” in diagnosis of spinal degeneration. Meaning that in order to diagnose any of these conditions you must have an MRI.
It would be expected that after your MRI findings it would be clear what intervention would be best for you, i.e. exercise, rest, NSAID’s, chiropractic, acupuncture, injections, surgery. This study shows that the use of MRI doesn’t change what treatment is recommended to the patient.
Of the 647 patients who had a lumbosacral MRI, 44.5% saw an orthopedic surgeon or neurosurgeon, and 6.5% received spine surgery during 3 years of follow-up. Of the 373 patients who had a cervical MRI, 44.0% were seen in consultation by an orthopedic surgeon or neurosurgeon, and none had spine surgery during 3 years of follow-up. Patients with severe disc herniation or severe spinal stenosis were more likely to undergo subsequent surgery.
“However, many patients with these MRI abnormalities did not receive surgery, and the absence of these MRI findings did not significantly lower the likelihood of subsequent surgery.” MRI scans almost always contain abnormal imaging findings, referral for surgical assessment is frequent, and subsequent surgery is infrequent.
Because of the lack of correlation between MRI findings and treatment the authors concluded that non-surgical spine specific physicians like chiropractors are the most effective way to manage these patients. in the event that these first line treatments don’t work then surgical care is warranted.
If you have had an MRI and have found the presence of degenerative disk disease, stenosis or herniation please contact us for our expert opinion on your best options. You can set up a free ten minute consult with our experienced doctors here.
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