Lumbar Discograms and MRI imaging
Posted by Dr, Green on 2009-07-03 13:32:24
Two recent studies were presented in the most recent The Backletter this month, July 2009, Vol. 24, No. 7.
First, Eugene Carragee, MD and colleagues from Stanford found that discography speeds disc degeneration over a 7 to 10 follow up period...(discograph) "resulted in accelerated disc degeneration, disc herniation, loss of disc heigth...". Discography is both radiography and a pain provoking procedure where a contrast medium is injected into the disc to see it better while taking a picture and to see if this injection reproduces pain. It is usually done to identify candidates for surgery. This new studysuffests that puncturing the disc has far greater risks than previously thought.
Two, THE OVERUSE OF SPINAL IMAGING HAS LITTLE TO DO WITH PATIENT'S CLINICAL CHARACTERISTICS
H.H. Pham, MD and colleagues analyzed Medicare claims from 2000 to 2002 and 2004 to 2006 assessing the appropriateness of imaging based on National Committee on Quality Assurance (NCQA) protocols. They found significant overuse of imaging in the Medicare population with 88% getting xrays and 11% getting CT or MR scans. Of interest, large group practices were more likely to order early imaging than small group practices. It was pointed out by Richard Deyo, MD, that 'giving into patient demands for imaging may send the wrong message' for example in a 1987 study, Deyo, et al. it was found that when xrays were performed for low-risk patients with back pain, it heightened patients' expectations that imaging should be a standard part of the back care process.
Of note, one month ago I wrote a paper about this exact same topic, how Xrays and MRs should not always be the first thing your doctor does because MANY times, there are false positives or no disctinct pain generator shows up on the picture.
Happy Fourth. Happy Birthday America!