Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 79

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.

"MRI Clinical Protocols"


NOTE: The following protocol represents my personal opinion and in no way represents, dictates or implies your patient’s clinical needs.

That is a decision based upon the findings of your patient and is your sole responsibility.

 

I have gotten much feedback about my personal approach to ordering MRI’s and my level of aggression. Many of you think that I order MRI’s on every patient that is in an accident because that is what will make the case for the lawyers and in order to have a huge PI practice, that is what you need to do. This couldn’t be further from the truth.

 

First, let’s be clear. A doctor should never order a test for a patient based upon the legal case or to make a lawyer happy. To be blunt, I don’t really care about the lawyer and the case; all I care about is making an accurate diagnosis, prognosis and treatment plan. I also happen to be expert in reporting my findings to the lawyer in an admissible format. However, that does not influence my judgment on whether or not I should order a diagnostic test. For MRI’s specifically, my clinical protocol and that of the neurosurgeons I work with is the following:

 

If the patient has positive clinical findings of radiculopathy or myelopathy, then an immediate MRI will be ordered and adjustive care will not be rendered until an accurate diagnosis is determined. I do not guess. I wait until I have conclusive evidence as to why those findings exist. If there are no radiculopathic or myelopathic findings, I will then wait 6 weeks post-conservative care to see if the pain pattern resolves; if not, only after 6 weeks of conservative care will I consider an MRI.

 

Regarding the MRI’s, there must be thin slices, STIR views, gradient or preferably FFE studies and stacking views in the lumbar spine. These are all things you need to know and will be taught in the MRI Certification Course. We are bringing our game to a new level of clinical excellence and these types of MRI studies ensure that a COMPLETE diagnosis is rendered, so you can accurately diagnose your patient in creating a prognosis and treatment plan.

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