The devout Spinal (con)Fusion readers out there know that I often wish that patients didn’t have access to their MRI reports. I am all for patient being fully informed about their conditions so that they can make the best decisions about their care (why do you think I spend so much time writing articles to educate all of you?). My concern is that the average patient just isn’t equipped to understand the detailed information as well as the confusing, often scary verbiage found in a typical MRI report. Words like “spondylosis”, “compression” or “herniation” can provoke fear or panic in the average patient, especially when combined with descriptors such as “prominent” or “severe”. This fear and panic then leads to the patients becoming fixated on these words as if they indicate some terminal condition that can only be treated surgically.
Some radiologists are like the Chicken Little of medicine and over emphasize findings on studies as if some sort of neurosurgical catastrophe is imminent. The radiologists should understand, however, that for some patients these words in the reports become like badges to which some sense of importance must be applied. The words begin to weigh heavily on a patient’s psyche and when unchecked can become a prominent part of their identity. They begin to think that “YES! Something IS wrong with me! I must hurt.” You can see how this lends significantly to the psychological component of learned pain.
Thankfully most patients are quite receptive when I explain their MRI reports for them and are relieved to find out that things really aren’t that bad, that in fact the findings are all part of the normal degeneration that occurs with aging. You can see their faces brighten as they immediately begin to feel better. Some patients, however, are disappointed and even angry when I don’t offer surgery based solely on their MRI findings (as in when their symptoms don’t correlate with the findings.) “But is says severe! Why aren’t you going to do something?!” they say. In a recent study in the Journal of Neurosurgery Spine by Franz et al patients were given a questionnaire in order to better understand common misconceptions about spinal surgery. When asked “Would you be willing to undergo surgery if your MRI reports abnormalities, even if you do not have symptoms?” 52% of patients said yes! Other studies have shown that a high percentage of patients believe that radiographic studies like MRI can definitely determine the cause of a patient’s pain. This data suggests that patients put way too much importance on the findings on an MRI versus, say, a detailed physical examination or a discussion with their physician.
Here’s the kicker: many studies have shown that findings such as spondylosis or bulging discs are routinely found on the MRIs of normal, asymptomatic patients. The findings may be completely incidental and have nothing to do with the patient’s back pain. Don’t read your MRI report, or at least don’t become too fixated on what it says. Definitely never undergo surgery based on MRI findings alone (I’m looking at you Laser Spine Institute) lest you end up with surgery that may be unnecessary and even harmful. Talk with your surgeon to determine if the findings in the MRI report are actually causing your symptoms. Let your surgeon treat you, not just your MRI.
Thanks for reading!
J. Alex Thomas, M.D.
Franz EW, Bentley JN, Yee PPS, Chang KWC, Kendall-Thomas J, Park P, et al.: Patient Misconceptions Concerning Lumbar Spondylosis Diagnosis and treatment. J Neurosurg Spine Published:1–7, 2015