How Come my Doctor did not order an X-Ray?

How Come my Doctor did not order an X-Ray?

How Come my Doctor did not order an X-Ray?

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That is a question often asked of me and my staff.  The better question is “Why should you get an X-ray for back pain?”

The answer to that question is “It depends.”

I know.  you want a better answer.  But,  there is a logic to the response.  The most important determining factor on the need for x-rays is the HISTORY.  By telling your Doctor the reason for the visit, your Doctor will determine if there is a benefit to ordering the X-ray.

Let me give you a hypothetical scenario.  What if you are a healthy 30 year old man,  with no history of back problems.  Yesterday,  you helped a friend move into his/her new apartment.  During the move,  you felt a bit sore, but  after your friend offered a thank you beer,  you felt fine.  This morning,   you experienced a mild back ache.  Should you see a doctor and get an x-ray?

I think most people would opt to give it a bit more time to see if the soreness will naturally go away.  99% of the time it will.  The answer to the question is NO, you do not need to see your Doctor or get an X-Ray.

In the second hypothetical scenario,  You are a 65 year old woman with a history of osteoporosis (brittle bones), and you tripped and fell on your front porch.  You have immediate sharp pain to the middle of the back.  You have pain whenever you inhale, and it is difficult to walk without pain.  In this scenario,  you should certainly contact your physician, and if he/she is not available,  you might consider making a visit to a walk-in clinic or an emergency room.  By history,  there is a strong potential for what is known as a compression fracture. If warranted, your Doctor may get an x-ray to confirm or rule-out this possibility.

By these examples,  you can see how the history is very important in determining the needs for tests such as x-rays.

X-rays should be ordered if there is suspicion of  a broken bone, a dislocation, or in rare instances,  as a screening test for potential cancer or infection.  Beyond those problems,  spinal x-rays rarely help in the diagnosis or treatment of the typical episodes of neck and back pain.

I know many of you will say,  “But my doctor discovered I had spine arthritis with the x-ray.”  The statistic is that after 40, almost all of us will have some evidence of arthritis of the spine based on x-rays.  The better question is,  does the x-ray discover of spine arthritis change the treatment plan for the average patient?  As you can guess, the answer is no.

Often times,  x-rays will demonstrate the early disk degenerations and bone spurs of aging.  I like to make the relationship of balding or greying hair.  We all get it eventually.  The x-rays findings of degeneration of the spine is like the visual effect of seeing our greying or balding hair.  It happens.  You cannot reverse it.    And,  just because you see arthritis on the x-ray, it does not mean that the arthritis is the cause of your neck or back pain.  Face it.  X-rays for neck and back pain are not helpful in the vast majority of patients.  X-rays should be reserved for situations where we suspect a broken or dislocated bone.    Even in the face of infection or cancer,  the x-ray is just a general screening tool, and if there is strong suspicion,  more that just an x-ray is necessary.

The usual scenario that I see as a spine surgeon is the patient has back pain.  The patient has expectation of testing, so the x-rays are ordered by some one.  By the time I see the patient,  often times the pain is vastly improved, and the patient needs some basic counseling on exercise,  use of NSAID medications, weight management and smoking cessation.  The x-ray usually did not reveal anything other than arthritis.

Every once in a while,  there will be a patient that has a significant finding, unrelated to their back pain, discovered on x-ray. That patient will point out how that x-ray discovered the problem.  But the truth is,  that problem, if significant enough, will be discovered anyways.

So why am I trying to convince you that x-rays are not always necessary?  Because there are also risks of x-rays.

X-rays of the lower back subject you to the equivalent about 80 chest x-rays.

X-rays findings can often lead to costly and time consuming over-treatment of findings.

X-ray findings can also mislead you on the real diagnosis.

If you have neck or back pain, give your Physician a thorough and accurate history of this episode of pain.  Then he/she will determine the need for additional testing.  If the pain does not go away within 4-6 weeks,  it is likely that your physician will refer you to a specialist, or order screening tests to make sure you do not have a more serious condition.  But,  if your Physician  does not order an x-ray immediately,  maybe it is because your Physician thinks it will go away, without subjecting you to all the risks of an x-ray.  Maybe your Physician is not  testing you on purpose.  Maybe your Physician thinks the risks of x-rays are not necessary.  Maybe your Physician is just being a good Physician.  Ask him/her about it.

Citations

  • Armstrong MP, McDonough S, Baxter GD. Clinical guidelines versus clinical practice in the management of low back pain. Int J Clin Pract. 2003 Jan-Feb;57(1):9-13. PubMed PMID: 12587934

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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