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SPINAL EDUCATION

Doctor, Am I Crazy?

Spinal related disorders are not only the most common ailments affecting our society, they are among the most painful and most misunderstood by the medical profession. An example of this is patient Ron Miles. Six months after an emergency disc surgery Ron was in so much pain he seriously contemplated suicide. His doctor prescribed pain medication but his condition continued to deteriorate. Ron consulted with his doctor but the response he received made Ron more despondent. “My doctor thought I was crazy, that my pain simply couldn’t be that bad, he didn’t believe me!”

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When the MRI Lies

Magnetic resonance imaging is the single greatest advancement in the diagnosis of spinal pathology since the introduction of x-ray by Wilhelm Röntgen in 1895. MRI provides the clinician with a precise picture of the pathologic anatomy of the spine. The technique has been maligned because of its lack of specificity particularly in patients over 60 where up to a 57% false-positive rate has been reported. This should not come as a surprise since we have known for years that the clinical symptoms of acute disc herniation and spinal stenosis can be transient leaving the patient with a demonstrable pathologic lesion asymptomatic. It is up to the clinician, not the radiologist, nor the MRI scanner, to decide whether the anatomic lesion discovered by the test is clinically significant.

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