In the many thousands of patients who have visited us, in more than 95 percent of our patients, we find that the true diagnosis causing the pain is different from the diagnosis the patients had been previously given.
Very rarely will a doctor acknowledge a ligament or tendon injury as a cause of chronic pain. The main reason is because they find abnormalities on MRI scans. Ironically most MRI findings have nothing to do with why the person has pain and this is the reason for most back surgery failures.
“Nearly one-fourth of patients undergoing lumbar discectomy demonstrated radiographic evidence of recurrent disc herniation at the level of prior surgery, the majority of which were asymptomatic.
Asymptomatic disc herniation was not associated with clinical consequences by 2 years. Clinically silent recurrent disc herniation is common after lumbar discectomy.
When obtaining MRI evaluation within the first 2 years of discectomy, providers should expect that radiographic evidence of reherniation may be encountered and that treatment should be considered only when correlating radicular symptoms exist.”1
Sadly many surgeons proceed with low back surgery after misdiagnosing the cause of pain. Even worse, the uses of MRI’s seem to be increasing and are even being performed in surgeons’ offices. A study recently released by the Stanford University School of Medicine showed that MRI scan rates increase when a doctor buys or leases MRI equipment. The study also showed that patients were 34% more likely to receive back surgery when they had an MRI scan done by their doctor. In other words, seeing a doctor who has an in-office MRI scan increases your chances of getting a scan and getting surgery. Interestingly, the study author noted that MRIs and surgery are controversial because there are no proven benefits. She goes on to say that most people with low back pain do not need an MRI and even fewer need surgery. Therefore a patient should take caution when his doctor prescribes an MRI, especially if it is in the same office because your chances for receiving surgery may be increased. Unfortunately most doctors send patients straight to an imaging test without performing a physical examination or health history to determine the root cause of the problem. Since imaging tests tend to show abnormalities, even in patients with no pain at all, root causes of pain are misdiagnosed and wrong treatments are chosen.
1. Lebow RL, Adogwa O, Parker SL, Sharma A, Cheng J, McGirt MJ.Asymptomatic same-site recurrent disc herniation after lumbar discectomy: results of a prospective longitudinal study with 2-year serial imaging. Spine (Phila Pa 1976). 2011 Dec 1;36(25):2147-51.