Spinal surgeries are typically recommended after an MRI reading showed some type of degenerative disc disease. Some people have successful spinal surgeries and do well. Yet, many others have the surgery, but the pain remains. Many people thought, “what else could I do?” Yet, many patients were not presented with other options beyond surgery, painkillers, or “live with it.” Others, on the other hand, have had an MRI, but experience no back pain, yet surgery was recommended.
Why does this cycle continue? Researchers, interestingly enough, HAVE been identifying this problem that everyone knows about, but little is being done, IE too many people are getting unnecessary MRIs, and this is causing unnecessary surgeries. Overdiagnosis occurs when diagnostic imaging detects incidental findings that are common in the asymptomatic population and provides the patient with a diagnostic label that brings them no benefit or may even cause harm when they receive unnecessary surgeries.
A recent British Medical Open Journal article by the University of Sydney states, “Little is known about how to reduce unnecessary imaging for low back pain. Understanding clinician, patient, and public beliefs about imaging are critical to developing strategies to reduce overuse.” Yet, patients AND clinicians believe diagnostic imaging is an important test to locate the source of low back pain, thus providing evidence that the pain is real for the patient; and clinicians feel imaging protects them from risking a possible missed diagnosis that might lead to possible litigation. Radiologists are now even saying that we are doing too many inappropriate MRIs and that research underestimates the true extent of how many inappropriate MRIs are ordered for back pain.
In treating degenerative disc disease and spinal ligament damage, our 25 plus years of experience tells us that we can get answers with a consultation and physical examination in combination with musculoskeletal ultrasound whereby damaged structures that do not show on MRI are revealed. We have written about this in prior articles, but here are some of the reasons that patients suffer from failed back surgery. First, surgery did not address the actual cause of the patient’s pain. The diagnosis was incorrect. The main cause of “missed” low back pain is injury to the sacroiliac joint. If your MRI showed degenerative disc disease and you had the discs operated on, but the SI joint was not addressed, the pain will continue after surgery. Secondly, the surgery itself made the back more unstable because part of the bones in the spine were removed. Thirdly, a secondary problem may have been missed even though the primary problem was addressed. IE you had two problems. Fourth, you sat too much after surgery. Sitting kills. Period. Finally, in rare situations, scar tissue forms and pinches on a nerve.
Bottom line here: MRI is not the final truth. More than 50% of patients receive MRIs who really do not need them. Do not agree to surgery that you may not really need. Positive findings on MRI do not necessarily mean that you need surgery. Utilize non-surgical methods to repair degeneration in the spine such as Prolotherapy. Work on proper posture. Stop sitting so much and get up and walk or walk in your pool! Work with a qualified Physical Therapist to help you if you cannot do it on your own.
