MRI Findings Not Helpful in Determining Herniated Disc-Related Sciatica Treatment

MRI Findings Not Helpful in Determining Herniated Disc-Related Sciatica Treatment Blog  Sciatica

When a patient complains of pain from a herniated disc or sciatica, the first test a doctor will order is an MRI. This test is often used when pain is radiating down the back of the legs. It allows doctors to see the severity of the situation. Additionally, it shows the doctor whether or not surgical intervention is necessary. An MRI will show if there is an issue with a compressive nerve. However, recently, using the MRI to decide on surgery has become quite controversial. According to an article recently posted in the Journal of Neurosurgery, they discovered that this hallmark test has absolutely no way to help a doctor decide on surgery or a patient’s prolonged care.

Sciatica and Regression

Patients suffering from their first bout of sciatica usually, they have a good prognosis without the need for surgical intervention. Sciatica treatments are able to allow patients to have some resolution within 6-8 weeks of their initial diagnosis. When dealing with herniated discs in the lumbar area, there is a 96 percent sequestration rate of regression, a 70 percent rate for extrusion, and a 41 percent rate of a protrusion. Oddly enough, when the lesion is severe in nature, it has a better long-term prognosis, according to researchers. Sciatica treatments are not always necessary, specifically, when non-compressive sciatica is present, it often resolves on its own.

Study Proves MRI Findings Not Everything

A study of 283 people proved interesting to doctors. Those studied were dealing with their initial episode of sciatica. To meet criteria, these people needed symptoms that ranged from 6-12 weeks in duration, and they must experience pain that radiated through their back and legs. Some dealt with nerve compression identified by an MRI, others did not. They divided into two categories, those that has received conservative care and those that choose to have surgical intervention early on. Within the conservative group, there were 55 people that had surgery before their one-year visit.

One Year Changes Everything

When nerve root compression was notated on an MRI, the patients recovered at a higher rate than those who didn’t have any compression issues. These people were in less pain at their one-year follow-up appointment. Using the Roland Disability Questionnaire, often called an RDQ, it was ironic that their back pain scores decreased. Disc intrusion patients saw a higher rate of recovery, and they had less leg pain at their one-year follow-up appointment. However, their RDQ scores were not favorable.

Similar Outcomes Are Shown

Strangely enough, the disc herniation size was not directly associated with the patients’ recovery rate. In the conservative group, it did not alter their decision on whether to have surgery. There was 21 percent within the group that presented with the large disc herniation. Surprisingly, the larger herniation group did not have a favorable outcome within the surgical group. The clinical expectations were not helpful. It didn’t matter whether the person had surgery or prolonged conservative treatment, it appeared that everyone faired equally.

Findings On The Effectiveness of An MRI

Two previous studies showed similar results, which baffled clinicians. A problem within the sciatica can be both compressive and non-compressive, or at least that is one explanation of the test results. Those who suffer from the non-compressive versions of sciatica may have a harder time with spontaneous resolution. The patients that had a clear nerve root compression on their MRI, seemed to have an overall better prognosis.
Clearly, the test showed that an MRI is not a good indication, of whether surgery or conservative care is the best answer. However, it may be helpful in predicting a patient’s prognosis when dealing with sciatica. It did not prove to be beneficial in deciding whether a patient needed surgery or not, but it does give doctors a better view of the interior issues.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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