Patients will hear me say over and over “MRI is really only for surgical planning. If you’re ready for surgery, then you need an MRI.” It doesn’t tell you “what’s wrong” or tell us if you need surgery or not. I ran into a research study today that demonstrates my point.
Won’t the MRI Tell Me ‘What’s Wrong?’
No, not really. Just like a picture of your face doesn’t tell me how well you breath, or how well you can smile or speak, or whether or not your face hurts, an MRI doesn’t tell me much about how you are functioning. Sure, if I saw a picture of a beaten, black and blue face, I could assume you were in pain, so in gross instances, an MRI will, in that way, let you know something is wrong.
This surgeon’s ad encourages prospective patients to obtain a “Free MRI/CT Scan Review,” then tells the story of a patient who drove hours to see the surgeon and was scheduled for surgery after his MRI review.
The problem with imaging (and the difficulty with many diagnostic tests) is that they often show “normal abnormals.” Most adults by a certain age have bulging disks, and most adults by a certain age have at least one herniated disk. Many adults without any pain whatsoever, will have a disk that has herniated, with a fragment or part clearly touching a nerve root.
A careful physical examination and evaluation of your problem, including your ability to function, move, etc, will in most cases, can point clearly to those cases for which surgery is required. For example, if you have weakness in a particular group of muscles, you have a reflex difference side to side, and you have numbness in an area of your leg, and all three are associated with a particular nerve root.
A particular set of findings on MRI do not make you a candidate for surgery. Your signs and symptoms and their response to treatment (or lack of response to treatment) can make you a candidate for surgery.
While these examination findings indicate the source of the problem (something impinging on a particular nerve root) they do not indicate whether or not surgery is needed. If, over the course of a few days or weeks, the numbness becomes more profound or the weakness gets worse, despite treatment in physical therapy (or you lose bowel/bladder control) then you may be a candidate for surgery. On the other hand, if you improve with therapy, then so long as you are improving you are generally not a candidate for surgery.
What Makes Me a Candidate for Surgery?
This study was performed looking at MRI findings on a prospective basis. In other words, they only included patients with MRI evidence of disk herniation, and then randomized patients to two groups. One group had surgical interventions, while the other group was limited to “extended conservative care, and surgery if needed.” They were unable to associate a particular MRI finding to someone that ultimately benefited from surgery.
The size of the disk herniation and whether it compressed a nerve did tend to predict who had more leg pain…but then asking the patient “how bad does your leg hurt” accomplishes the same goal.
So if you want to know how bad your pain is, and you really don’t know how bad your pain is, an MRI may help. If you are going to have surgery and your surgeon wants to know what he is going to cut, then get an MRI. If you are just wondering “what’s wrong” then ask for a thorough examination and explanation of the examination findings.
