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CT scans and MRIs may not be reliable indicators of the source of pain

On December 9, the New York Times published an article addressing the increasing controversy over abnormal findings on CT scans and MRIs.  The Times talked to the authors of two separate studies that found radiological abnormalities in just about as many healthy, pain-free individuals as were present in patients seeking treatment for pain.  The studies involved patients with knee pain and back pain.

The first study was conducted by Dr. David Felson of Boston University Medical School, and involved MRI scans on 991 people between the ages of 50 and 90.  Published in the New England Journal of Medicine, Felson's results showed that meniscal tears were just as common in people with knee arthritis without pain as they were in patients with arthritis but no complaints.  The authors concluded that a 60-year old guy has a 40 percent likelihood of suffering a meniscal tear, which is probably the result of arthritis and probably not the cause of knee symptoms.  If the symptoms are present, they, like the mensical tear, are probably the result of arthritis.

The second study was conducted under the supervision of Dr. Michael Modic, chairman of the Neurological Institute at the Cleveland Clinic.  They scanned hundress of people with no back complaints and found that spinal abnormalities, including herniated discs, were common.  "Between 20 and 25 percent" of the patients scanned had a herniated disc, with or without symptoms of pain.  As many as sixty percent of healthy adults with no pain complaints have some degree of degenerative changes in the spine, radiologically.  About one-third of the herniated discs disappear, without treatment, in six weeks; two-thirds disappear within six months.

In a follow up study of 250 patients who complained of back pain, Modic performed a scan at the onset of care and repeated the scan six weeks later.   Sixty percent of patients had herniated discs.  Thirteen percent of the patients still had a herniated disc after six weeks; the herniation disappeared in fifteen percent.  These findings did not correlate, however, with patients' pain.  Many without radiological findings continued to have pain and many whose pain had subsided still showed evidence of abnormality on scan.  Further, patients' knowledge of the follow-up scan result did not affect their recovery.  The consensus conclusion:  patients should be treated conservatively, initially [without surgery, in other words] and surgical decisions should be based on the history and physical findings, NOT ON RADIOLOGICAL FINDINGS.

One of the more interesting and certainly the most ironic ramification of these studies is the implication for the "serious impairment of bodily function" requirement under Michigan's no fault law.  In an effort to restrict the number of cases that could be pursued by accident victims, Michigan legislators adopted the requirement that an injury be "objectively manifested".  At least in the case of knees and spinal injuries, the evidence necessary to meet a threshold for compensation may be irrelevant to the issues under consideration.

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