Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 24

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

"Beware of the MRI Interpretation"


Over the years, a neurosurgeon who is a close friend, warned me of incorrect radiologists’ interpretations of MRI’s. His perspective was that if the read was wrong and he operated, the outcome could be disastrous to the patient. We, as chiropractors, can ill afford a misread. Other than the surgeon who cuts, chiropractors introduce a high velocity thrust into the patient’s spine for the correction of vertebral subluxation and a misread by the radiologist can also be disastrous to our patients and our practices.

 

There are many contraindications to adjusting a spine, and most are related to space occupying lesions in and around the cord and/or nerve roots. These “risk factors” are always diagnosed via imaging and advanced imaging, x-ray, MRI and CAT scan, and we, as a profession, largely rely on the interpretation by the expert, the radiologist, for guidance. Just yesterday, I did 2 P-IME’s for an attorney and compared the MRI reports to the film. The radiologist was 0 for 2 in accuracy; both films were misread. The first reported a cord compression at C4-5 and the second reported a normal C5-6.

 

The first had no cord compression. The radiologist read only the saggital view, ignoring the axial view, and therefore, this patient was not adjusted by the chiropractor because of the cord compression reported by the radiologist. As a result, this patient suffered for 4 years with no care, as the chiropractor would not adjust (correctly) a spine with cord compression. The doctor referred the patient to an orthopedist, who in turn sent her to physical therapy. If the chiropractor was able to interpret the MRI’s independently, this patient would have stayed under his care and the patient would have gotten better. Good for the patient, good for the doctor’s practice!

 

The second patient, in spite of the normal interpretation by the radiologist, had a broad base herniation compressing the cord, as the radiologist apparently read the MRI slice that was through the vertebral body and not the disc. As a result, the doctor, thinking everything was normal, vigorously adjusted the patient’s spine. Over a short amount of time, the patient got worse and wound up needing surgery. The doctor was eventually sued and the case was settled out of court. As a result of money being paid, his state, as is mandatory, had an investigation and found him guilty of gross misconduct, taking his license away and levying a serious fine against the doctor. His defense was the MRI was interpreted by the radiologist incorrectly. The answer from the state board was the doctor is responsible for the film and the care of the patient, in spite of the radiologist.

 

As a side note, nothing happened to the radiologist who misinterpreted the film, as it was deemed it was the chiropractor’s actions that caused the harm. Not fair, but factual.

 

The moral of the story is you have to be able to read what you rely on. Not ordering the MRI leaves you exposed, and not being able to pick up a bad read also leaves you exposed. The solution is simple; learn to read MRI’s. You do not have to become a radiologist; you need to understand the basics. Get the knowledge and the credentials and protect the wellbeing of your patients, your practice and your license. Being the “best-of-the-best” is more than just a platitude!

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