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…