Which herniation -- or both? -- is causing pain?
We love to look at pictures! Pictures remind us of the fun we had, the places we've visited, the source of our pain...at least in xrays and MRIs and CT scans... sometimes!
MRI and CT Scans
Sometimes must be added in this discussion because MRIs and CT scans and xrays make beautiful pictures, but they can't relieve your pain. Sometimes imaging will reveal several issues which then forces the doctor to correlate the symptoms and clinical examination findings to determine which imaging issue is causing the problem right now for you. Sometimes the MRI, CT scans and xrays reveal nothing even though you suffer with pain which then forces the doctor to rely on your symptoms and examination to reveal the diagnosis.
Imaging May Be Deceiving
Advanced imaging can be deceiving. Just as your family picture at the water park shows smiles on everyone's faces and you know that two of the kids just had to be separated because they were zinging each other with towels, imaging doesn't always tell the whole story.
- Medical literature reports that up to 76% of asymptomatic (non-pain) people will reveal disc herniations in their spines. (1)
- Pre- and post-care MRI studies of patients who had pain and now have none show that the patient's disc herniation after care when there is no more pain is smaller, the same size or even larger than when treatment began.
"How can this be?
" is usually the next question. It comes back to the fact that there can be mechanical irritation alone
(disc's pushing on the nerve directly or another condition causing stenosis of the canal and pressure on the nerve) or chemical irritation
(disc's nucleus pulposus material leakage onto spinal nerves) or, oftentimes, a combination of both. Images must be correlated with clinical findings to determine the cause of your pain.
Imaging May Not Be Necessary
Advanced imaging is not always necessary. Medical literature reports that advanced imaging is not always necessary until after 4 to 6 weeks of unsuccessful conservative care. (2) There is no correlation, even, between the disc size or type and pain and disability. (3) If you are getting worse or experience bowel/bladder function problems, however, imaging is warranted sooner. In many cases, treatment at New Hampshire Spine and Sport may conservatively, non-surgically alleviate your pain for less cost than an MRI or other imaging series.
Know, though, that, if you need imaging, your doctor will order it. If you already have imaging, bring it with you. Our staff at New Hampshire Spine and Sport will consider its pictures as an additional insight into your condition alongside your clinical examination findings to uncover your diagnosis to determine your treatment plan.
Typical Imaging Studies in the chiropractic Office
Xrays are typical in initial evaluations. Xrays give a look at the structure of the spine. Xrays reveal any structural abnormalities that the doctor may need to consider. They are simple, but most helpful.
Xrays are windows into the spine's structure and advanced imaging studies such as MRI and CT are doors leading to the inner workings of the spine. Both have their place in your care, but their place is alongside the clinical examination, not in place of it. The role of advanced imaging studies should confirm the clinical examination's diagnosis, not make the diagnosis alone.
You are in good hands at New Hampshire Spine and Sport in Southern New Hampshire that know how and when to put images to good use in order to help you regain your quality of life. Contact us today.
Jensen MC: MRI of the lumbar spine in people without back pain. N Engl J Med 331.1994 (MRI should be done only after 4-6 weeks of conservative care has failed as it was found that in asymptomatic patients, 52% have a disc bulge, 27% have a disc protrusion, and 64% had a disc abnormality.)