Can a Chiropractor confirm no disk herniation?

[tennisenthusiast]

I mean, based on X-rays, how reliable is Chiropractor's diagnosis of no disk herniation detected? No offense intended to Chiropractors.

[Itagaki]

Originally Posted by tennisenthusiast

I mean, based on X-rays, how reliable is Chiropractor's diagnosis of no disk herniation detected? No offense intended to Chiropractors.

Probably very low. Unless the herniation is so severe it causes the vertebrae to be noticeably displaced, no one is going to be able to tell based on an xray

MRI's are needed to diagnose it

[ollinger]

A chiropractor tell you that you DON'T have a particular problem!!!

[LuckyR]

The more important question is: regardless of their training, even if someone can make the diagnosis of disc herniation, can they tell you with certainty that it is causing the symptoms that made you go see them in the first place?

[PrimeChoice]

In my opinion, chiropractors are not real doctors. They beleive that ALL disease and illness comes from back problems. Well maybe they don't all beleive that but that's what "their" journal of medecine teaches them.

I WOULD NEVER TRUST A CHIROPRACTOR'S ADVICE OR DIAGNOSIS.

It's all hocus pocus 4 them.

Go to a Orthopedist who specalizes in backs. They are the only ones' who can help. Also, get an MRI done. You'll probably need one of thoes.

[tennis_tater]

Originally Posted by LuckyR

The more important question is: regardless of their training, even if someone can make the diagnosis of disc herniation, can they tell you with certainty that it is causing the symptoms that made you go see them in the first place?

Well, I think it depends on what the symptoms are that the patient is complaining of, but I think if an ortho or neuro is treating a patient for complaints of leg pain/leg weakness, then obtains an MRI that confirms the existance of a disc herniation and the probability of nerve impingment , and then does further neurological testing (i.e., EMG) that shows specific irregularities with the nerve whose nerve root is adjacent to the level where the disc herniated is located and where the nerve is believed to be impinged based upon a review of the MRI, then I think that individual can be fairly certain in opining that the disc herniation is the cause of the lower leg issues.

[tennis_tater]

Originally Posted by tennisenthusiast

based on X-rays, how reliable

As others have said, completely unreliable. An MRI is needed.

[junbumkim]

It depends on the chiropractor, but my experience has been very good with them.

What are your symptoms? I have had back problems for about 3 years, and no doctors thought X-Ray or MRI was necessary because the symptoms weren't consistent with herniated disc and a scan was more likely to show findings that weren't causing any problems...My chiropractor who was the last professional I saw thought the same...

If you want to be more definitive, try seeing a sports medicine doctor if not an orthopedist.

[LuckyR]

Originally Posted by tennis_tater

Well, I think it depends on what the symptoms are that the patient is complaining of, but I think if an ortho or neuro is treating a patient for complaints of leg pain/leg weakness, then obtains an MRI that confirms the existance of a disc herniation and the probability of nerve impingment , and then does further neurological testing (i.e., EMG) that shows specific irregularities with the nerve whose nerve root is adjacent to the level where the disc herniated is located and where the nerve is believed to be impinged based upon a review of the MRI, then I think that individual can be fairly certain in opining that the disc herniation is the cause of the lower leg issues.

Makes sense, but given the high rate of MRI confirmed "disc herniation" in the general population, the presence of it is not highly correlated with causation.

From the groundbreaking (but by no means only) study of it's type that all show basically the same thing:

"We performed magnetic resonance imaging on sixty-seven individuals who had never had low-back pain, sciatica, or neurogenic claudication. The scans were interpreted independently by three neuro-radiologists who had no knowledge about the presence or absence of clinical symptoms in the subjects. About one-third of the subjects were found to have a substantial abnormality. Of those who were less than sixty years old, 20 per cent had a herniated nucleus pulposus and one had spinal stenosis. In the group that was sixty years old or older, the findings were abnormal on about 57 per cent of the scans: 36 per cent of the subjects had a herniated nucleus pulposus and 21 per cent had spinal stenosis. There was degeneration or bulging of a disc at at least one lumbar level in 35 per cent of the subjects between twenty and thirty-nine years old and in all but one of the sixty to eighty-year-old subjects. In view of these findings in asymptomatic subjects, we concluded that abnormalities on magnetic resonance images must be strictly correlated with age and any clinical signs and symptoms before operative treatment is contemplated."

[El Diablo]

^^ The conclusion here is obvious and reflects standard treatment. Nobody operates on asymptomatic patients. In fact, hardly anyone operates on symptomatic patients unless the herniation is quite severe and has not responded to other therapies. (A flaw in this "groundbreaking" study, unless you've left out important information, is that there's no mention of the SEVERITY of the herniations in these asyptomatic patients; that asymptomatic persons can have trivial herniations has long been known.)

[LuckyR]

Human nature is also obvious and there are many incentives in a Fee for Service world to connect the dots in a patient sitting in your office with symptoms and an abnormal scan to perform a highly compensated procedure like back surgery, even if the findings of the scan are moderately abnormal (not severely so). Perhaps you missed the word: "substantial" in the citation.

And yes these findings are "long known", since the first studies are from the early 90's.

[El Diablo]

^^ Incentives are mostly the other direction. Patients with mild findings have a hard time finding someone to operate on them these days. Colleagues of mine are constantly turning away patients they don't feel are likely to benefit from surgery. Disappointed patients can be very litigious so doctors don't want to deal with someone they think won't improve. Managed care insurance companies also often won't approve payment for procedures without very significant findings. Starting next year hospitals' payments will in part be related to patient satisfaction surveys, yet another disincentive from doing too much surgery. In general these days, it's not so easy for someone with borderline findings to find someone to operate on him.

[LuckyR]

Isn't it interesting the different incentives between Managed Care (what you are speaking of) and Fee for Service (what I was refering to)?

[junbumkim]

Originally Posted by LuckyR

Human nature is also obvious and there are many incentives in a Fee for Service world to connect the dots in a patient sitting in your office with symptoms and an abnormal scan to perform a highly compensated procedure like back surgery, even if the findings of the scan are moderately abnormal (not severely so). Perhaps you missed the word: "substantial" in the citation.

And yes these findings are "long known", since the first studies are from the early 90's.

That's why many doctors will not order scans unless the symptoms were severe enough (i.e.. extreme loss of strength in a leg, paralysis, etc). And, it's widely accepted among physicians that scans will lead to false findings that are not causing any problems.

If a physician opts for surgery, it's because he's a orthopedic surgeon who believes surgery is the best solution. Perhaps there are few doctors who lick their chops and think "Yeah, surgery, more money." but it rarely works out like that.

[LuckyR]

Originally Posted by junbumkim

That's why many doctors will not order scans unless the symptoms were severe enough (i.e.. extreme loss of strength in a leg, paralysis, etc). And, it's widely accepted among physicians that scans will lead to false findings that are not causing any problems.

If a physician opts for surgery, it's because he's a orthopedic surgeon who believes surgery is the best solution. Perhaps there are few doctors who lick their chops and think "Yeah, surgery, more money." but it rarely works out like that.

As usual, real life is a lot more nuanced than black and white. For example: if you are convinced (as the surgeon) that back surgery, with all of the potential risk and hassle associated with it, has a 97% chance of curing the symptoms, or a 3% chance, you know what to do. OTOH, if you know that at this point, the surgery has a 60% chance of getting rid of pain, let's say, that is another way of saying that it has a 40% chance of being a useless surgery. Do you do the procedure?

[junbumkim]

Originally Posted by LuckyR

As usual, real life is a lot more nuanced than black and white. For example: if you are convinced (as the surgeon) that back surgery, with all of the potential risk and hassle associated with it, has a 97% chance of curing the symptoms, or a 3% chance, you know what to do. OTOH, if you know that at this point, the surgery has a 60% chance of getting rid of pain, let's say, that is another way of saying that it has a 40% chance of being a useless surgery. Do you do the procedure?

Not sure if you are trying to say doctors will make decisions based on the money, but i will let you have the benefit of doubt.

The answer is "it depends". If we are talking specifically about back surgery to relieve pain, the answer is probably "no" based on the evidence. However, there will be cases where surgery could provide significant pain relief.

If a patient is experiencing growing weakness in legs and losing control of bladder / bowel function, then surgery may be worthy considering even with low success rate.

Medicine itself is never an exact science. There are aways risks and chances that the procedure may not resolve any symptoms. And, it is always risk vs benefits and other variables.

[ollinger]

Don't know how much time LackeyR spends in medical staff lounges, but I'm in one every day and talk to surgeons about this all the time. Two points stand out in my mind. One is that surgeons are generally not eager to operate on people with disk issues unless they feel it will be helpful. But the other vital point is that people with chronic and severe back pain are a desperate lot who suffer constantly and not infrequently become suicidal over their plight, not to mention addicted and abusive of opiates. The question posed about whether a surgeon should or would operate if he sees a 40% chance of benefit is naive; for comparison sake, should an oncologist administer chemo if he sees a 30% chance of cure? Most would say "of course" if the alternative is death. People with severe chronic debilitating back pain often feel the same way; they see their affliction as a death sentence and will beg surgeons to operate even if there is a less than even chance of benefit. Even in the non managed care setting, which still exists to some extent, people usually have to shop around to find a surgeon who will operate.

[samarai]

Well let me shed some light. In the majority of the cases, for you to have a disc herniation, the bony contours ( what you see on the xray) will also have corresponding changes. Remember the disc is sandwiched between the two bone. I can take an xray and if the bony contours look all normal between the vertebral body and the disc space is equal throughout then more then likely I can ascertain that you don't have a disc herniation. I would never make that diagnosis without a MRI but you get the jest. Secondly, studies have shown that if you were to MRI the adult population, half of them would have positive changes for bulges and herniations.

[floridatennisdude]

X rays see bones, discs are not bones. If you haven't had an MRI, which sees tissue, you don't know if the disc is busted or not.

Chiros treat symptoms, they don't fix problems. I'd rather be treated by a high school athletic trainer than a chiro. If a chiro makes you feel better, you could probably save a bunch of money by taking an anti inflam and stretching.

[WildVolley]

Originally Posted by floridatennisdude

X rays see bones, discs are not bones. If you haven't had an MRI, which sees tissue, you don't know if the disc is busted or not.

Chiros treat symptoms, they don't fix problems. I'd rather be treated by a high school athletic trainer than a chiro. If a chiro makes you feel better, you could probably save a bunch of money by taking an anti inflam and stretching.

How much experience do you have with a Chiro?

I went to a chiropractor after messing up my shoulder from serving too hard. My upper neck/back muscles were locked up, and I was in a state of constant discomfort. The adjustment caused an immediate analgesic effect that was much stronger than taking analgesic drugs, and range of movement was greatly improved.

I don't want to claim I was in some way cured, but the chiropractor had me doing neck traction and posture and shoulder exercises. It took me about six months of rehab to get the shoulder fairly healthy.

The main point is that chiropractor-type adjustment can sometimes have a huge and instantaneous reduction in pain. The immediate drop in pain and increase in range of movement was far greater than I was getting from drugs and without any sort of other unwanted side effects.

I don't believe that all disease can be cured by adjusting the spine, but I now understand why chiropractors can stay in business. People who dismiss the pain reduction possible in some cases don't know what they are talking about.