Tests – what are they good for?
In the realm of back pain tests, of
MRIs that question must be examined. What are MRIs good
for when the proportion
of constructive, influential MRI studies is so small?
False positive MRI results trouble those who get
such results. They inspire fear or caution where it
is not always needed. MRIs like this confuse the
proper treatment plan. They spend a lot of money.
Dr. Hoang's Chiropractic Clinic carefully weighs the necessity of
MRI in the Montreal chiropractic treatment plan of Montreal
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% found
anything that needed to be addressed. Of the 36 MRIs that roused
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 shows 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 Dr. Hoang's Chiropractic Clinic, to correlate all such
findings with patient symptoms. (1,3) Your Montreal
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 worrisome). (4) A review of the success
of the Canadian Choosing Wisely recommendations for imaging nonspecific spinal
pain and symptoms reported 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. Dr. Hoang's Chiropractic Clinic wants what’s
best for our Montreal chiropractic care patients.
COX® TECHNIC’S VIEW
Chiropractors like yours at Dr. Hoang's Chiropractic Clinic review
all the symptoms, tests and images our Montreal chiropractic back
pain patients [[present on|bring with them39] their first Montreal
chiropractic visit. So many back pain patients present to
Dr. Hoang's Chiropractic Clinic with MRI images already done.
Dr. Hoang's Chiropractic Clinic will look at them but will rely more on clinical exam findings and link them to what the MRI reveals.
A rule of thumb with the Cox Technic System of Back Pain Relief is to work
toward 50% decrease of back pain in the first month
of care before arranging additional imaging or
testing or referring for surgical consultation. (6)
CONTACT Dr. Hoang's Chiropractic Clinic
Listen to this PODCAST
with Dr. Dan Clark on the Back Doctor’s Podcast with Dr. Michael Johnson as he explains
the role of imaging for back pain in the program of treatment
for pain relief.
Schedule your Montreal chiropractic appointment
with Dr. Hoang's Chiropractic Clinic today. Let us discover together
the best path to Montreal back pain relief – with or without MRI