MRI diagnostic clinical validity (sophisticated, but still misleading, imaging).
The common misconception and abuse in detecting (diagnosing) and guiding treatment is foolproof test (i.e. falsehood claimed accuracy of 25%-40%). However reliance of such "tests" is clinically false, because imaging of passive/static abnormalities are incompatible to active/dynamic physical examination and history taking findings, unless correlated accordingly.
Research showed that on 5.000 patients MRI tested, 75% displayed variety of spinal disorders, but none were clinically symptomatic! Spine degeneration is normal in adults due to fact that adults spine are deformed, thus becaming symtomatic or asymptomatic. Errors are due to non-specialistic care procedures, hence misrepresentation within correct integration of clinical examination.
Common factors are financial and non-specialistic. The most important is a history and physical examination, which can not be substituted by anything else. 99% of spinal disorders are mechanically based. Even evaluation of "sensitivity" of clinical diagnostic study (false negatives) and "specificity" (false positives) must be interpreted truly. Accordingly, MRI ratio has shown a significant false/positive ratio in asymptomatic people with a variety of abnormalities in over 20% and over 40% of people over 40. Clinically spinal cord impingement has shown 10-15% in younger individuals, 20-25% of older. In lumbar spine 22% of asymptomatic patients under age of 60 and 57% of over 60 had a significant abnormality of MRI scan.
DISC degeneration (so called "dark disc disease"), was found near 98% in subjects over age of 60. The crucial part of such facts are proof that "normal ageing" is not clinically valid (as seen on scan), being a normal irrevocable process, yet not any cause of patients symptoms.
Such facts confirm a complete falsehood of any surgery based upon untrue facts. Imaging study is surgeon best friend (false diagnosis) and patient worst enemy (life disability). General screening is dangerous (though financially sound!) and leads to a patient life disability.
Costly and misleading studies are not proven... and yet in USA 850.000 useless opoerations are carried out by "ethically enthusiastic" (!) surgeons with active help of "hardware" corporations to a turn-over of 28 billion USD (of so called) industry.
TThe phrase "We will get an MRI scan to see if there is anything wrong with the spine" is a false journey into dark unknown.
No wonder that surgeons and others so called "spine related self-acclaimed specialists" are clinically blind and operations are carried being clinically false.
CLINICAL CONSIDERATIONS OF SPINAL PATHOLOGIES
Many spinal conditions can cause pain directly or indirectly. Orthopaedic Medicine specialistics are best to diagnose. Specialistic history and examination (no MRI scan, x-rays... they have 5% validity that is for fracture only) are crucial for identyfing the most serious pathology (eg..: fracture, malignancy, infection or cauda equina syndrome). Above conditions are fortunately rare, less than 0.5 % of total disorders, 99% being mechanical deformities, trauma and/or mixed).
Two criterias are applied :
1. Yellow flags assessment for chronic pain and life disabilities (all surgeries = FAILED BACK PAIN SYNDROMES = psychosocial personality disorders):
- Yellow flags
- Red flags
- sickness behaviour (e.g.: prolonged rest);
- belief that pain/activity are harmful;
- lack of support / social withdrawal;
- work dissatisfaction poroblems;
- emotional mood personalities (negativity, passiveness, stress, depression, manipulative personality (cheating);
- application for social benefits/claims compensation;
- overprotective family;
- time of work (6 weeks plus)
- addictions (alcoholism, smoking, drug abuse...);
- irrational behaviour of treatment expectations ("surgery miracles", lay "expert self-believe = knowing it all -lay zero education, no or "little" knowledge is very dangerous, self-diagnosis, useless tests- ).
2. Red flags (serious conditions):
- LBP (low back pain) can be caused by variety of pathologies (adjacent structure) being : thoracic/hip spine, visceral (pelvis/abdomen, kidney, ovaries, bladder );
- CES (cauda equina syndrome = nerve trauma/compression/damage ). Symptoms are: leg weakness, loss of bowel/sexual functions, sensitivity changes around rectum/genitala ( saddle anaesthesia);
- inflammatory conditions (rare): ankylosing spondylitis, polymyalgia rheumatica, rheumatoid arthritis (very rare cause of LBP), coccydinia;
- infections: shingles before rash development, post-herptic neuralgia, discitis, osteomyelitis, bacterial/tuberculous, epidural abcess (post-surgical), neoplasm (secondary bone deposits);
Red flags are serious pathology indicators, never certainity (chronic back pain indicates suspicion of such conditions). Further investions/referral should be considered in case of several red flags. Clinical experience judgement is crucial (e.g.: cancer/non-immediate referral, ces -immediate). Serious underlaying pathologyis not common. Specific questions are required to clarify (e.g. perineal numbness ). CES (medical history essential): saddle anaesthesia, recent bladder disfunction, faecal incontinence.
Physical examination: perianial sensory loss, laxity of anal sphinster, severe/progressive deficit of lower extremities, major motor weakness/knee extension, ankle eversion, foot dorsiflextion. Spinal fractures: medical history: major trauma. fall, strenous lifting, osteoporosis, sudden onset of central pain in the spine, which is relieved by laying down.
Physical examination: structural spinal deformity. Cancer or infection: medical history: age plus 50 or under 20. History of cancer: constitutional symptoms (fever,chills, unexpected weight loss), bacterial infection (e.g. : recent urinary tract). Drug abuse (intravenous), immune suppression, pain remaining supine, night pain = sleep disturbance/thoracic pain (aortic aneurysm ?). Myeloma /or rare primary cancer. Metabolic bone disease: osteoporosis (= vertebral collapse), osteomalacia, paget disease. Asymptomatic (degenerative + structural changes): Spondylosis (spinal osteoarthitis + osteophythosis (bony spures) + degenerative facet and discs ( ddd) ), spondylolisthesis/retro listhesis (forward /backward displacent with/without stress fracture in the pars interarticularis),
severe scoliosis/kyphosis (idiopathic?).