Why an MRI Is Not the Best Ligament Injury Imaging Test
In this article, I want to cover the role of MRI for spinal injuries. Many of you who are familiar with my work, have read or heard me talk about MRIs before. An MRI is not the best test, it’s certainly not the best primary test for ligament damage to the spine.
Let’s Dig into What the Proper Role of An MRI Is When It Comes to Spinal Images
Generally speaking, MRIs are used as secondary imaging studies when it comes to spinal injuries.
Today, MRIs are basically disc studies.
There are over 220 specialized ligaments that hold the spine together. These are very important ligaments. What these ligaments do is they hold the spine in alignment through all its various movement patterns.
They ensure that the spine stays aligned during all its stresses so that it cannot mis-align.
Remember, the spine is packed with lots of different tissues:
- Spinal Cord
- Spinal Nerves
- Blood Vessels of the Spine
- Fat in-between to cushion it all
These components are all packed in there, really tight. Very compact.
It’s About More Than 23 Ligaments Labeled as Discs
Of the 220 ligaments in the spinal area, 23 of them play a specialized role as discs.
MRIs are very good for disc studies and determining whether you have a disc herniation.
This is one of the things where MRIs really shine. When we damage our spine, we have two bio-imaging markers.
Now, a bio-imaging marker is defined as something that you see on imaging that shows an internal body condition.
The first is picked up on imaging. For example, the imaging of an MRI.
The second is excessive motion. Anytime you damage a ligament, you can cause excessive motion and it’s the amount of excessive motion that tells you just how sever that ligament injury or that sprain is.
It also tells you what joints are involved.
When we consider spinal-injuries we are most concerned with excessive motion.
We can use an X-ray or CT scan to tell us if a patient has a fracture. That’s pretty straight forward.
When we are looking at excessive motion injuries which are the most sever type of ligament findings.
Excessive motion is detectable on stress X-rays. These X-rays are readily available. However, they need to be subject to:
Computerized Radiographic Mensuration Analysis (CRMA)
This system relies on a team of board-certified medical radiologists with spinal kinetics which is a medical testing company for ligament injuries.
Any time we have an injury patient we need to have our injury interpretation performed by an independent set of radiologists.
These independent radiologists must be board-certified and highly skilled in this area. Using independents is important because it drives many facets of the injury market:
- Patient care
- Treatment plans
- Reimbursement from insurance carriers
It also is important that this part of the diagnosis be performed by someone else because it gives the doctor leverage with attorneys and insurance companies.
Finding this excessive motion is the most important part of the process. You could also order an MRI, but the fact is the MRI was never designed to pick up excessive motion. This does not make MRIs deficient; it just means they weren’t designed for this process.
So, let’s say that you have a disc herniation and these disc herniations usually repair quite will, depending on the size and the location of the disc herniation.
But… One of the factors that complicate a disc herniation is excessive motion. This is especially true if there is excessive motion damage to the ligaments directly above or below the site of the herniation. This leads to one of the most serious axial ligament injuries that you can have in the cervical spine.
What patients find frustrating is that they’re often working with doctors who don’t even realize an injury of this magnitude is present.
These patients need doctors who realize that the MRI is not the end all bell of spinal injuries. Even if an MRI reveals a herniated disk, we still need doctors who order a set of stress X-rays and send those out for a qualified interpretation.
Doctors can then correlate these findings to a motor sensory or a pain problem that the patient is experiencing.
That is what being a SmartInjuryDoctor is all about. It is knowing how to easily combine these radiological studies with the conditions and symptoms you observe with the patients.
This is the role they play in the injury market.
This becomes their primary test for spinal injury. These doctors also realize that if they have a patient with an excessive motion injury, it may be warranted to order an MRI to check for a herniated disc in the area of the spine where the patient is having difficulty and pain.
Whether you are dealing with an individual patient or a set of patients from one employer who has lots of employees that are complaining of the same injury, you need to understand the role of proper imaging in your practice.
We need the medical community to stop relying on the MRI and believing that a negative MRI means there is no damage. This is simply not true.
Let’s remember, there are ten ligaments holding two vertebrae together. Only one of them is a disc. The other nine will not get picked up on an MRI study, but are just as capable of creating pain and problems for injured patients.
Just remember the most effective way to detect excessive motion:
- Order a Stress X-Ray
- Send the film out for a qualified interpretation
- Correlate the areas of measured excessive motion to motor sensory or pain areas.
That is the best way to attack these injuries. Not relying on an MRI which can leave you blind to the fact that you have a patient with a severe injury. The pain is not in his or her head. You are just not using the best diagnostic tool to find the underlying cause of this pain.