LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

MRI

LUMBAR DISC PROBLEMS? YOU MAY HAVE THIS…

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Nothing in the body happens in a vacuum.  Every single systems interacts with every other system.   People at increased risk for heart disease are at increased risk of colon cancer.  Diabetes increases the risk for Alzheimers and Parkinsons.  So what about disc degeneration / arthritis of the lumbar spine?

First of all, we need to understand what contributes to disc degeneration in the lumbar spine.  Several factors have been identified.  Genetics may play a role, but it’s likely to be the smaller role.

There are some strong associations between cardiovascular disease and disc degeneration.  The inside 2/3 of the disc does not have its own blood supply, but rather gets its nutrients from small blood vessels in the bone of the vertebral body above and below.  These small blood vessels may very likely be what links heart disease and disc degeneration. 

Early atherosclerosis (plaquing of the arteries) due to cardiovascular disease, will reduce blood flow through these small blood vessels and thereby reduce nutrient delivery to the inside of the discs.  In addition, the outer 1/3, which does have its own direct blood supply, will also be affected by this plaquing.

Less nutrients means less ability to heal which means a greater likelihood of breaking down faster.  This leads to early onset disc degeneration.  So what does this really mean? 

It means that disc degeneration, because it is occuring throughout the body, is not going to be limited to only one area of the spine.  Supporting this, this study finds links between lumbar disc degeneration and cervical disc degeneration.  As a matter of fact, in those patients who had lumbar disc degeneration, almost every one (98%) had cervical disc degeneration.

However, in the control group who had neither low back or neck pain, 88.5% had disc degeneration in the cervical spine.  Wow!  That’s a really high number.  Keep in mind these people were pain free, and yet the vast majority had “problems” found on MRI.  Consider this next time your primary care doctor orders an MRI and refers you for a surgical consult…

WHAT HAPPENED AFTER YOUR MRI?

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It doesn’t happen all the time, but it is not uncommon for a patient to call our office to cancel an appointment because they went to their PCP, the PCP ordered an MRI and now they have to see a specialist. Sound reasonable?

There are multiple layers of “wrong” in this scenario. First and foremost is that, in most situations, we have already identified whether a disc bulge / sciatica was present based on talking to the patient and our exam finding. At this point, without any type of red flags, it is never, ever recommended to order an MRI this early in the treatment. Happens all the time, but apparently, those ordering the MRI are not reading the studies.

Not only is this a tremendous waste of resources, but it is well documented that this starts the patient on a MRI to epidural to surgery pathway, despite evidence that this is not the best pathway for the patient. It is also far too common for the PCP to steer the patient away from chiropractic care to a specialist–when chiropractic care is exactly what they need.

So what about the epidural’s effectiveness in the case of chronic (>12 weeks) radiculopathy (leg pain)? This particular study finds it worse than worthless—actually giving a small injection of saline was massively more beneficial than the steroid injection (Oswestry change after 52 wks– saline 14.3 points improvement, epidural 1.9 points worse). So basically, the epidural clearly made the patient worse as time went on.

The bottom line is that chiropractic care, for all musculoskeletal complaints, is the best place to go to get the best outcomes for your pain. Let the chiropractor decide if an MRI and epidural is appropriate.

DID YOU HAVE AN MRI FOR LOW BACK PAIN?

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There are definitely times when knowing less is a good thing.  It occasionally happens where a patient who has signs and symptoms of a disc herniation presents to our office.

Based on an exam and the history given by the patient, disc involvement (bulge, herniation, rupture, etc…) can be diagnosed and treatment started.  A full blown disc bulge may take several days to start to show a response, but the outcomes are usually very good.

Sometimes, it is not a disc problem that is causing the patients’ low back and leg pain.  Sclerotogenous referral from the hip (I really love the word “sclerotogenous”–makes me sound smart) or involvement of the fascia is also notorious for causing leg pain.

Sometimes, it may take a few days to be able to tell the difference.  Certainly an MRI would be helpful, right?  Not so fast…

You see, there is a large chunk of the population that has disc abnormalities on MRI (we can argue about the percentages, but let’s just agree that not all disc abnormalities on MRI cause problems).  We have also seen that MRIs done before and some time after a patient has a disc bulge don’t change much, even though the pain may be gone.

This particular study contributes to what any chiropractor can probably tell you.  MRIs increase the risk of having surgery.  Sounds strange…I mean–how could having an MRI affect your back?

It’s the mindset and the potential diagnosis of a disc problem, even if the disc problem is not what is causing a patient’s pain.

In this study, when the primary care doctor or orthopedic doctor had a financial incentive to order an MRI (usually because the unit was installed in their clinic) the number of MRI for low back pain went up.  In addition, in the orthopedic surgeon’s office, the number of patients getting surgery went up 34%. 

Just something to consider the next time you THINK you need an MRI… 

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