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MRI and Diagnosis

February 11, 2021
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"So it's really common for MRI imaging results to confuse and worry my patients. MRI imaging is incredibly advanced and looks at the differing water density in bodily tissues to construct an image. So it's a great tool to identify worrisome diagnoses like cancers and infections. It's also really powerful and identifies a variety of findings related to aging, or just the way you were built or the way you developed. Aging related changes like disc bulges and sprains and strains, osteoarthritis, disc herniations, spinal stenosis, and also incidental findings like Tarlov cysts and hemangiomas are quite common. It shows so much detail that the majority of findings in it don't even drive the reason the patient comes in. For example, if you take a hundred people that are over age 60 without any pain, 90 of them will have degenerative disc disease. 35 of them will have disc herniations and 35 of them will have spinal stenosis.

So these findings commonly occur and don't predictably cause symptoms. So the clinical process is to first ask the patient where the symptoms are and then look at the MRI and see what fits. So when the patient asks, how bad is my MRI, they're really asking doctors to predict how bad they should feel and what the future holds and what the prognosis is. This is a totally valid question, but it overvalues the MRI, and doesn't take into account the dozens of variables that are involved in pain and the prognosis. So while only more drastic surgical interventions change the anatomy of the spine, many other interventions improve the patient's pain and function. So other variables such as muscular strength and flexibility, body alignment, and body awareness and coordination, restricted movement of adjacent joints, local inflammation, systemic inflammation, and central nervous system inflammation, cardiovascular fitness, obesity, and the mind's contextual interpretation of pain matter immensely when it comes to interpreting pain signals."

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