Thirty Percent of Lumbar Intervertebral Disc Herniations Are Missed on MRI

herniated disc

Since its inception, the MRI has been a single straight forward answer to subjective complaints as it relates to traumatic soft tissue injuries, primarily disc herniations. However, the clinical examination is the single most important step in determining the patients diagnosis, treatment plan, subsequent prognosis, and need for further diagnostic studies.

This article is a review of the original article published in SPINE Magazine discussing the accuracy of traditional MRI studies in the diagnosis of lumbar Intervertebral disc herniation. A study that was published in the journal Radiology in ’95 revealed that, in cases of acute sciatica, only 70% of the patients that were diagnosed with a lumbar disc herniation based on clinical examination were actually confirmed by MRI. So, that leaves 30% of the patients with disc herniations that were not revealed on traditional MRI studies. If you are suffering from an acute lumbar disc condition and an MRI has not revealed a herniation, this article is a must read!

We must first understand the concept of a functional lesion. Once a patient is out of the initial acute inflammatory phase, they will describe a variable degree of pain throughout the day depending on the activity. This will depend upon the position and biomechanics of the spine, such as walking up or down steps, standing, sitting, or bending. The time of day may also cause these changes in severity, which is influenced by the amount of water content of the disc at that time. Therefore proper spinal alignment is an important factor, as different positions will have different effects on spinal anatomy as well as symptomotology.

There are three important concepts that will shed some light in relation to the lumbar spine and functional positioning:

  1. 1. Lumbar Extension-this will place heavy loading of the posterior elements of the spine (facet joints) in turn, decreasing the size of the intervertebral foramen.
  2. 2. Lumbar Flexion-this increases posterior interdiscal pressure which is associated with sitting and standing.
  3. 3. Lateral Lumbar Flexion-take either lumbar extension or flexion and induce the lateral flexion component, and you will also compress nerve root elements on the same side. In addition to that, lateral flexion will increase interdiscal pressure and compress the facet joint on the side flexed to.

Most doctors will agree that flexion and extension X-Rays and CT studies are effective in diagnosing lumbar disc herniations, however the MRI reveals images that are far superior in clarity. Doctors have been experimenting with ways of using MRI to obtain Positional Images of the spine.

This thinking has ushered in the concept of the Functional MRI Studies. Which simply means imaging patients in the position of most pain. Just like in the Chiropractic field, the doctor will X-Ray the spine in a weight bearing position in order to determine the most accurate spinal alignment in order to pinpoint the causative factor of imbalance or spinal subluxation. A recent MRI study took this into account and revealed some interesting facts. Not only were more disc herniations visualized and, therefore, diagnosed, but also those that were present, increased in size when Function Positioning was implemented. A significant increase in the degree of lumbar disc herniation was found by lumbar Flexion and Extension MRI views when compared with neutral views alone.

In closing, the first step upon developing a possible lumbar disc condition, in my opinion, should be a thorough examination by a Doctor of Chiropractic (D.C.) The reason is for their high degree of success in resolving disc conditions. The next step would be an MRI that is performed under the Functional MRI concept, (placing the body in the position of greatest pain). The final step would be starting a strict regimen of Omega III’s along with an Isotonic OPC in order to reduce the inflammatory component of the disc herniation. Hopefully, this will clear up some of the confusion about diagnosing and some treatment recommendations for the typical lumbar disc herniation.

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Dr. Barry… the Healthy Life Dr.

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