MRIs - The Positives and the False Positives
Tests – what are they good for?
When it comes to back pain tests, of MRIs that question must be questioned. What are MRIs good for when the proportion of useful, influential MRI studies is so minor? False positive MRI results upset those who get such results. They inspire fear or caution where it’s not always warranted. MRIs like this blur the proper treatment plan. They cost quite a bit. Yorkville Chiropractic and Wellness Centre carefully weighs the need for MRI in the Toronto chiropractic treatment plan of Toronto back pain relief.
MEDICINE’S VIEW
Interpretations of MRI images by radiologists often vary. The true-positive finding rate was 56.4%, and the miss-rate was 43.6%. (1) MRI imaging may produce misleading suspicion. When following the guidelines of the American College of Radiology, 93% of lumbar spine MRIs were proper. Of those, only 13% found anything suspicious. Of the 36 MRIs that provoked 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 indicate that these are signs of normal aging. They remind all doctors, remind chiropractors like yours at Yorkville Chiropractic and Wellness Centre, to correlate all such findings to patient symptoms. (1,3) Your Toronto chiropractor does this!
CHIROPRACTIC’S VIEW
Choosing Wisely guidelines for American chiropractors suggest30 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 effectiveness 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 objective of guidelines is less imaging, fewer false positives. Yorkville Chiropractic and Wellness Centre wants what is best for our Toronto chiropractic care patients.
COX® TECHNIC’S VIEW
Chiropractors like yours at Yorkville Chiropractic and Wellness Centre study all the symptoms, tests and images our Toronto chiropractic back pain patients [[present on|bring with them39] their first Toronto chiropractic visit. So many back pain patients come to Yorkville Chiropractic and Wellness Centre with MRI images already done. Yorkville Chiropractic and Wellness Centre will study 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% reduction of back pain in the first month of care before arranging more imaging or testing or arranging surgical consultation. (6)
CONTACT Yorkville Chiropractic and Wellness Centre
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 Toronto chiropractic appointment with Yorkville Chiropractic and Wellness Centre today. Let us discover together the best path to Toronto back pain relief – with or without MRI imaging!
