Against the Grain with Dr. Chad Edwards | Back Pain Healing Tulsa| Podcast 10 – Part 3
Started doing some research. I found out that MRI wasn’t at all what I thought it was. Brief intro to MRI, it’s Magnetic Resonance Imaging and basically you’ve got a very strong magnet that causes the hydrogen ions to vibrate and they vibrate at different frequencies, so the computer can put all that together and you determine these different densities and you get a 3-Dimensional picture of the structures. An MRI is extremely sensitive, meaning that it will pick up any little thing. The sensitivity of the MRI is very good, but it’s not specific. In other words, it will detect everything, it won’t tell me if that’s exactly why you hurt. That’s the crux of my issue. Get MRIs on low backs and you see these herniated discs and you see all this stuff, but their clinical symptoms aren’t consistent with that.
Let’s talk about some of the literature that’s out there. The first one is a study that was done by Boos, B-O-O-S, not B-O-O-Z-E. This was published in 1995. He did a study of 96 patients that had absolutely no back pain and absolutely no history of injury. He ran all 96 patients through MRI. No pain, no previous injury. 76% of those normal, healthy, asymptomatic patients, 76% of them had disc herniation on their MRI. 17% had minor nerve root compression. 4% had major nerve root compression. This is a big deal, we need to intervene. 85% had degenerative disc disease.
I get patient that come into my clinic and they say, “On my MRI I’ve got this degenerative disc disease, holy cow, what am I going to do about this?” Nothing, because 85% of the people had that on their and they had no symptoms, so why? Why do you care? Then 13% had what was called a disc extrusion, that’s basically where the disc has blown up and chunks of the disc are floating around in the spinal canal. I’m sorry, the jelly is leaking out. You know, if you squeeze a jelly doughnut and all I can think about is Private Pyle. “A jelly doughnut.”
Brian: There you go again, doctor humor.
Dr. Edwards: Exactly.
Brian: My dad was a minister, I’m used to minister humor and doctor humor kind of all falls in the same category.
Dr. Edwards: Yeah?
Brian: Yeah, we’ll talk about it later. I don’t want to offend you on the show.
Dr. Edwards: You’ll offend me later.
Brian: I’ll offend you later.
Dr. Edwards: All right, anyway, there were a lot of abnormal findings and some of them can be severe on patients with no problems.
Brian: What’s interesting to me is again, the common listener here, is how highly sensitive they are. I didn’t know how sensitive it was and it can pick up every little thing, which is not necessarily a diagnostic tool, to say that there’s always cause and effect, causality. I’ve got a question. Marshall is our technical guy here. He’s an athlete. You can tell. Looks like a white Michael Jordan. His name is Marshall Mathers, which is Eminem. He’s our tech guy here. So, Marshall, seriously, have you ever had an MRI?
Marshall: I’ve never had an MRI.
Brian: In all your years of professional basketball?
Marshall: In all my years of professional basketball, still no MRI.
Brian: As handsome and as athletic as you look, I actually was an athlete. Chad will tell you.
Dr. Edwards: He ran track.
Brian: Some people say that I was okay at track. I wouldn’t be one of those people.
Dr. Edwards: I think one of your records still stands.
Brian: Many, Chad, many. I don’t think it has anything to do with track, though.
Dr. Edwards: When you say many, are you referring to the size or are you referring to the number?
Brian: Either. There’s that. I have had MRIs and in my experience, the MRI was somewhat inconclusive in determining my result or origin of pain. Specifically, to your point, when it’s muscular in nature. I ripped my quadriceps, for example. I was a sprinter. I got an MRI and originally they had thought probably it was some structural problem that had caused stress on the actual tendon and they never could find a solution. They didn’t really ask a whole lot of questions, they just said, “We’ll give you a shot in your leg, boy, and get back on that track.” This was in the ’90s, before Marshall was born. I’ve never had, personally, great experience as an athlete with MRIs. Me personally.
Dr. Edwards: Right. I’m going to read this real quick. This was from a paper from the New York Times that was posted in 2011. Talking about MRI, they said is a very sensitive tool but it is not very specific. That’s the problem. Scans almost always find something abnormal, although most abnormalities are of no consequence. It is very rare for an MRI to come back with the words ‘normal study,’ said Dr. Christoper DiGiovanni, a professor of orthopedics and sports medicine specialist at Brown University. “I can’t tell you the last time I’ve seen it.”
Dr. Edwards: When I look at MRI results, I do not get them that say ‘normal study.’ I do on CTs. You don’t on MRIs. I’ve never seen it.
Brian: That’s interesting. I think that’s contrary to what most people would believe about MRIs.
Dr. Edwards: If you talk to a radiologist, all they’re doing is describing what they see. They’re not making a diagnosis. They’re just …
Brian: We’ve all been there. What are you looking at on the screen?
Dr. Edwards: Exactly. They’re just describing it.
Brian: They’re describing it. They’re storytellers.
Dr. Edwards: That’s exactly right.
Brian: It’s like observing a car wreck. “I saw the car wreck. Whose fault was it? I have no idea. This is what I saw.”
Dr. Edwards: The problem is not with the radiologist, because they’re doing exactly what they’re supposed to do. The problem is in us interpreting the radiologist’s read, or even, some physicians will interpret their own MRIs. Orthopedic surgeons definitely do. They may talk about it with the radiologist. If all you’re doing is reading this report, then it’s our responsibility to interpret that report appropriately and how does this correlate with the patient.