Review of “Patterns of Care After Magnetic Resonance Imaging of the Spine in Primary Care SPINE Volume 38, Number 1, pp 51–59 2012”
Spinal MRI is considered the “gold standard” in diagnosis of spinal degeneration. This study shows that the use of MRI has minimal significance on the clinical decision making of primary care physicians and minimal correlation with the interventions used. Health care utilization is not changed by MRI studies.
Of the 647 patients who had a lumbosacral MRI, 44.5% saw an orthopedic surgeon or neurosurgeon, and 6.5% received spine surgery during 3 years of follow-up. Of the 373 patients who had a cervical MRI, 44.0% were seen in consultation by an orthopedic surgeon or neurosurgeon, and none had spine surgery during 3 years of follow-up. Patients with severe disc herniation or severe spinal stenosis were more likely to undergo subsequent surgery.
“However, many patients with these MRI abnormalities did not receive surgery, and the absence of these MRI findings did not significantly lower the likelihood of subsequent surgery.” MRI scans almost always contain abnormal imaging findings, referral for surgical assessment is frequent, and subsequent surgery is infrequent.
MRI scan results do not discriminate between those who will and will not undergo surgery, non-surgical spine specific physician are the most effective way to manage these patients. Chiropractic should be tried for at least 3 months before deciding to undergo spine surgery as the surgery may not be necessary.
“Alternate models of health care delivery for individuals with spinal complaints, such as multidisciplinary spine assessment centers staffed by highly trained personnel, could potential result in more targeted use of MRI testing, may provide a more optimal pathway to transition patients from general practice to surgical care…” This is the goal in my clinic.
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