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Medical Forum / General / General / July 2005

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Can an MRI be Misleading?

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Vetro Chelly - 27 Jun 2005 19:37 GMT
Hi,

I had an MRI showing a disc prolapse at l4/5 level... it did not say,
nor did the doctor say, if it was pinching my nerve...

Thanks Vetro
Vetro Chelly - 27 Jun 2005 19:42 GMT
I must also add, that I am able to lift my leg, not 90 degrees, but
that's because my hamstrings feel tight
Sbharris[atsign]ix.netcom.com - 27 Jun 2005 20:19 GMT
>>I had an MRI showing a disc prolapse at l4/5 level... it did not say,
nor did the doctor say, if it was pinching my nerve... <<

Yeah, so?  Often you can't tell from an MRI, because there are plenty
of people with disc prolapses and no symptoms. So, you wasted
(somebody's) money. That's an old story.

The MRI is helpful as an aid to tell the surgeon where to cut in
patients who've *already* decided to have back surgery based on
clinical symptoms and findings and nerve conduction studies. But the
MRI is a very poor diagnostic tool in evaluating back and leg pain,
being neither sensitive nor specific. And it is horribly expensive.
Neverlessless, the temptation to use it is almost overwhelming. What a
horrible waste of resources.

And how many people have gone uselessly and fruitless under the knife
for back pain, because of the pretty pictures the damn MRI machine
spits out?  Argghhh.

SBH
Vetro Chelly - 27 Jun 2005 20:57 GMT
Well, the MRI was given to me for precautionary measures, I was
complaining about tingling in my perinium and pain in my UT...
Sbharris[atsign]ix.netcom.com - 28 Jun 2005 06:01 GMT
>>Well, the MRI was given to me for precautionary measures, I was
complaining about tingling in my perinium and pain in my UT... <<

As a precautionary measure?? You wanna have your back whittled on for a
tingle in your groin?

Here's what happens. You do an MRI for this, and see nothing. You docs
say: "Hmm, we don't see any cause for his tingling perineum."

Or, you do an MRI for this, and you see a herniated disk or spinal
stenosis. And your docs say "Hmm, that could be the cause of his
tingling perineum!  But we wouldn't cut unless it was a lot worse....."

SBH
mbraff@gmail.com - 29 Jun 2005 03:13 GMT
> And how many people have gone uselessly and fruitless under the knife
> for back pain, because of the pretty pictures the damn MRI machine
> spits out?  Argghhh.

So why is it that when:

   "You let the people with the problem and the market decide."

Things don't seem to work out so well?

Maybe we need some government intervention here to protect these
poor folks this unnecessary surgery.  

Marty
Vetro Chelly - 02 Jul 2005 11:57 GMT
Look, all I was trying do was ask a question, not get my head bitten
off because I was ordered an MRI...  I just have had multiple
diagnosis, SI joint, Facet joint and herniated disk... apparently,
according to all the physicians I saw, the symptoms all mimick each
other... I just want to know what the problem is so I can treat it and
get on with my life.... and wanted to know what people may think of
these medical opinions...

Now onto another question...

if it's mechanical problem, i.e si joint or facet joint, the pain would
not be constant right?  I seem to have tingling down my leg after a 20
min walk or when I initially get up or sit down, the pain usually goes
away after I sit down for 10 min... just wondering... it doesn't seem
like a disk even tho my mri said I have bulging disks...

Vetro
bae@cs.toronto.no-uce.edu - 04 Jul 2005 20:23 GMT
In article <1120301838.664204.326190@z14g2000cwz.googlegroups.com>, Vetro Chelly <vcellucci@gmail.com> wrote:
>Look, all I was trying do was ask a question, not get my head bitten
>off because I was ordered an MRI...

You had the bad luck to ask at a time when some posters were
particularly irked by the behavior of other posters, and not feeling
very helpful.

>I just have had multiple
>diagnosis, SI joint, Facet joint and herniated disk... apparently,
>according to all the physicians I saw, the symptoms all mimick each
>other... I just want to know what the problem is so I can treat it and
>get on with my life.... and wanted to know what people may think of
>these medical opinions...

Unfortunately, problems with the spine are common as the back ages, and
there are seldom any cures, just management.  Also, imaging of the
spine shows these kinds of changes in the backs of people who have no
symptoms at all, so imaging is not as useful for diagnosis as one might
wish.  It's possible that none of the things that showed up on the
MRI are what's causing your back problem.

I recommend you get one of the books by Hamilton Hall.  He's an
orthopedic surgeon who specializes in the spine, and is an
exceptionally good writer.  He writes a new book every 8-10 years as
the field changes.  I can't remember the name of the most recent book,
but the previous one is "The New Back Doctor", and I think it's a more
useful book.  His books describe the character and progression of back
problems, and what you can do to relieve the symptoms and reduce
recurrences, as well as diagnostic methods and treatment options.

>Now onto another question...
>
[quoted text clipped - 3 lines]
>away after I sit down for 10 min... just wondering... it doesn't seem
>like a disk even tho my mri said I have bulging disks...

Caveat: I am not a doctor.

Since certain positions aggravate or relieve pain from various back
problems, and the same positions may have different effects for
different people with the same problem, yes, intermittent pain or
discomfort doesn't rule out any of those problems, AFAIK.

You get tingling down your leg when something presses on certain spinal
nerves.  Often this is a disk.  The disk may shrink back into place in
a couple of months and the problem go away... until the next time.
The space for the nerve to exit the spine is very small, so small
changes in position may increase or decrease the pressure markedly.

IMHO, you should ask your doctor what he or she recommends as the next
step, if any.  Ask if there are any particular symptoms you should be
wary about, that should send you back to the doctor for reevaluation.
A referral to a physiotherapist specializing in back problems may be
helpful.  A physio may be able to help you identify things you do that
aggravate the condition (such as posture problems, or use of poorly
designed chairs or of desks at an inappropriate height, or bad methods
of lifting) and recommend exercises to strengthen the muscles that
support the spine and devices like footstools and support cushions that
may be helpful.

I hope this helps.  Best of luck to you!
outrider - 04 Jul 2005 22:19 GMT
The best thing you can do for your back pain is to stop asking your
doctor what to do for your back pain. If you keep doing that your
doctor is going to feel he/she must do something. That something will
likely be weighted to rcommending surgery. There. He/she's done
something for you. Surgery is not the answer. Learning to build your
musculature to support your spine properly is, and you are the one who
will have to do it.

You must take responsibility here.

Find a very good physical therapist who practises "active
rehabilitation". There will be a minimum of feel good therapy, and a
whole lot of sweat and tears. .

I would call my nearest university medical school faculty of
rehabilitation medicine and ask for names of three masters' degreed
physical therapists who work in active rehabiliation. I would also
contact the physical therapists professional association with a lot of
questions.

I am not speaking about something I've read about, or observed in other
people. I'm speaking from personal experience.

It works; for life.

Zee

> Look, all I was trying do was ask a question, not get my head bitten
> off because I was ordered an MRI...  I just have had multiple
[quoted text clipped - 13 lines]
>
> Vetro
Sbharris[atsign]ix.netcom.com - 04 Jul 2005 22:03 GMT
Sbharris[atsign]ix.netcom.com wrote:
> And how many people have gone uselessly and fruitless under the knife
> for back pain, because of the pretty pictures the damn MRI machine
> spits out?  Argghhh.

So why is it that when:
  "You let the people with the problem and the market decide."

Things don't seem to work out so well?

Maybe we need some government intervention here to protect these
poor folks this unnecessary surgery.
Marty

COMMENT:

We wouldn't, if they *paid* a big hunk out of pocket for the surgery in
the first place!  If they did, they'd put it off, and put it off, like
they do their major dental procedures and major car repairs, and lots
of other stuff people are reluctant to spend a lot of money on. After a
while, their backs wouldn't hurt so badly, and they'd realize they'd
just saved themselves a lot of dough due to application of that magical
stuff we doctors call Tincture of Time.  It would be a lot like
Canada's long waiting list for back surgery, except it would run itself
with no beaurocracy!  Think of it as "Invisible Hand Chiropractic (TM)"

If you look at randomized treatment of simple back pain with disk
herniation by surgery vs. "conservative management" (ie,
symptomatically with physical therapy and painkillers) you find that
after a year there's no difference in outcome. But a lot of
disappointed surgeons and radiologists and people who sell and own MRI
machines.

SBH
Terri - 04 Jul 2005 22:39 GMT
> Sbharris[atsign]ix.netcom.com wrote:
>
[quoted text clipped - 31 lines]
>
> SBH

I'm going to have to re-think my views on this one, since horror of
horrors, I agree totally with Steve Harris.
outrider - 04 Jul 2005 23:07 GMT
When did you change your tune on MRIs? The last time I heard anything
on this subject from you it was all about how backward Canada was not
having more than one per 100,000, what a real swell diagnostic tool
they were, and how much money they could save the medical system if
only there were MORE. Everywhere.

You made it clear you support MRI use and implied Canada having too
few--your judgement--was the reason we had such poor health care; your
judgement again.

So which is it? MRIsRUs{TM} or ... more restrained use?

Zee

> Sbharris[atsign]ix.netcom.com wrote:
> > And how many people have gone uselessly and fruitless under the knife
[quoted text clipped - 30 lines]
>
> SBH
Vetro Chelly - 05 Jul 2005 15:12 GMT
Thanks for all your replies :)  I tried the physiotherapist thing...
maybe I had a bad one, because but the only thing she did in our
session was talk about my symptoms.  In 3 mths of physio I was given 3
exercises and alot of talking?!  I ended depleting my insurance so I
would have to wait until the winter to try another physio.  I do keep
up my excercises and after 4 mths I'm starting to feel a little
better... but I'm not sure if it's just time or both that are
contributing... I'm now seeing a physiatrist who is trying
manipulations on me... he says my facet joint is jamed... it's not
moving when I bend over...

Anyways thanks again for the replies... I will try what I can... maybe
time is all I need and there is no magic cure that people keep telling
me there is...
Vetro
 
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