The MRI Enigma in Spine Injury Clearance
Written by Editor   
Friday, August 22, 2014 11:14 PM

With ever more sensitive imaging modalities we have progressively devalued the traditional methods used to evaluate the integrity of the spinal column in favor of more technologically advanced ones.  Despite decades of success in treating this pathology and clear evidence that clinically relevant spinal injuries present with obvious clinical signs, we have let anecdotal evidence get the best of us.  MRI identifies far more injuries than CT.  

MRI is prone to overcalling pathology. Even a surprising number of asymptomatic healthy controls, with no history of acute trauma, will have radiologically significant pathology found on MRI.  Furthermore, when findings on MRI are compared to the injuries identified during surgical exploration, MRI demonstrates a propensity for identifying lesions where none exist. Given this, it no longer seems appropriate to consider MRI the gold standard for defining disease in acute spinal trauma. Rather we should examine clinical follow-up and functional patient-oriented outcomes.

Although each of these culprits is responsible in its own way for the crisis we currently face, the real perpetrator of overdiagnosis is information and the ambiguity it hurls at us. We have clearly demonstrated that modern medicine in its current form is incapable of standing idle. Our desire to act far overwhelms our powers of reason.

Though the current data cannot definitively negate the utility of MRI in the neurologically intact patient with persistent midline tenderness, we can say its indications are few and far between. Used empirically, it will surely lead to far more harm than good.