7 Key MRI Findings You Need to Know | Podcast Ep. 144

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. This week we are going to talk about the seven key features of the disc on MRI that correlate to pain and objective quantification findings on an mri. So this is a great episode. If you look at an MRI once a day, once a week, once a year, this is going to be something that's relevant for your practice for sure. Today we're going to talk about seven disc features and this comes from a Spine Journal article titled Correlation of pain with Objective quantification of MRI images in Older Adults with with Chronic Low Back Pain. Of course, I'll have that linked in the show notes and I'll say it one more time. Spine journal in 2014 put out a research paper titled Correlation of pain with objective quantification of MRI images in Older Adults with Chronic Low Back pain. And you may be saying this already sounds like an oxymoron. Correlation of pain with findings on MRI historically have not been very good. So this paper is attempting to change that or at least look at some findings that may be more correlative than what we've looked at in the past. So again, as we know, research shows us that primary care physicians routinely order MRIs as a diagnostic tool for spine complaints. And paradoxically, again, we also know MRIs have traditionally had little to no correlation to pain and or function. Many times people go in, they have a radiculopathy, their primary. I'm just talking through the process right now. This is literally what's happening to hundreds if not thousands of people in your town right now. They have radiculopathy, pain, numbness, tingling shoulder, arm, leg, foot, ankle. They go in, see their primary care doctor, they get a medication. Lo and behold, the medication does not work. The primary care doctor says go get an mri and then when it comes back with a disc bulge, they say, oh my gosh, you have a disc challenge. Let's get you to the orthopedic surgeon for a consult and a neurologist as well for an injection. We've seen it happen time and time again. I won't stand on the soapbox too long here, but that is so important on why we bridge the gap and reach out to these other docs. People are not coming into your practice due to non exposure. Many times that's an awkward way of saying if you build a relationship, you will get more people exposed to chiropractic care without compromising what you do. I think that's a goal all of us should aspire to. And if you want to do that on your own, awesome. If you want free tools and resources, check out the evidencebasedchiropractor.com in the tab that says Free tools. And if you want help doing it, because we've done it hundreds of times, we know how to do it. If you. And we've had success, come on as a member. But I'll step off the soapbox now and continue with the research. Cause I know that's what you're here for. So we also know that positive findings on an MRI are often found on asymptomatic patients. There was that landmark study by the New England Journal of Medicine where they took roughly 100 people that were asymptomatic, put them through an MRI. Almost all of them had some sort of findings. The older you get, things are gonna pop up on an MRI whether you're symptomatic or asymptomatic. So it's imperative that we continue to look for advanced algorithms and markers which can correlate pain and function. And the percent MRI index is what this paper looked at and called and it's really what they thought of as the first step in that search. So we all know, again, getting back to the story of the people in your community and maybe going down the wrong path. We know that chiropractic care has been shown to be effective and safe treatment option for chronic low back pain. We know that it's not only been very successful spinal manipulation as the hallmark and adjustment as the hallmark of what we do as chiropractors, not only very successful in reducing pain levels, but also improving function outcomes in these patients. So I'm gonna read a few quotes from the paper and then we'll dive right into those seven disc features, as the researchers call them on this paper. And those seven disc features are really what you're gonna wanna pay attention to because they are the key items that you literally, you can start looking for on an mri. And I think it's gonna give a lot of good clinical information to you as well as you start to add this up. But I'm gonna read a few quotes from the paper first to set some context. So the researchers found, quote, chron is among the most important factors influencing the physical health of individuals older than 65 and affects around 25% of the population older than 70 years old. Basically that statement saying, this is a big deal and a lot of people are dealing with it. The researchers also found, quote, an MRI index parameter was calculated as the product of the disc's area and the sum of pixel intensities. So that's kind of what they characterized as the MRI index was the product of the disk area's surface and the sum of the pixel intensities. They also found, quote, quantified measurable parameters from Lumbar. Mr. Images have better correlation with patients chronic low back pain than subjectively scored parameters. You know, as my daughter would say, in that case, duh, Right. Quantified measurable parameters are better than a subjective scored parameter. No kidding. So research is really just laying things down there. But the seven features that they analyzed and looked at are really the important clinical points that I strongly feel that you can identify on pictures. Starting literally today. None of these seven features are going to be new to you. But thinking about them as the bucket or the lens by which you look through an MRI when it's musculoskeletal, when there's no red flags, right. Using these seven features is an awesome way to go clinically. So the seven features that they looked at were T2 signal intensity loss. That simply means on a T2 weighted image, the disc should have a dark outer rim and a light center. The nucleus pulposis. The inner part of the disc should be light, right? Because it's a high water content, it's well hydrated. So a T2 signal intensity loss just means dark disc. So that's one of the features, a T2 signal intensity loss, a darker disc than you'd expect. Another key feature, disc extension beyond the interspace. All those discs hang out between vertebra and they are supposed to have nice margins on the anterior and posterior aspect and lateral aspects for that matter. So the disc should hang out underneath the bones. If it starts poking its head out and extending beyond the inner space, that's another feature to look at. Nucleus pulposus shape is number three. If the nucleus pulpulsis shape is distorted, the more distorted it is, the more likely it is to be causing trouble. So again, recapping those first three, we have dark disc, disc extension beyond the inner space and nucleus pulposus alterations. Shape that is. So those are those top three. Number four is annular fissure or annular tear. If there's a tear in the disc, that's something you want to keep an eye out for. That is a key disc feature. Modic changes are the end plate changes that we see that can be inflammatory at times. Endplate integrity and then osteophyte formation are rounding out number six and number seven osteophyte formation, those big Cankerous or those big osteophytes sometimes hanging off the anterior portions. If they're connecting, that's when an auto fusion happens. Important to look at those. Certainly if they're extending also into the foraminal canals. Posteriorly we have the end plate integrity. That endplate should look nice and flat. So those things all go together to a certain extent. Right. Modic changes. Then you start to see endplate integrity changes and then you may see osteophyte formation. So from a certain extent they build one upon another. But let's rally down those seven disc features again. These are the key items. The more of these that you see on somebody's image, the higher correlation it's going to be between that and pain. And this just makes sense now when we put them and frame it that way. Right. If there's a degenerative disc, it's lost its signal, it's dark disc. If there's disk extension beyond the inner space, the nucleus pulpulsus shape is all out of whack. When there's an annular tear, modic changes, endplate integrity issues and osteophyte formation. The more of the. You don't have to have all of them, but the more of them that you have, the higher correlation it's going to give to pain. So they looked at it from. Also a Kirkcaldy Willis phase evaluation. I don't know if you've heard of this, but I want to. If you think of it in your mind's eye, think of it like a bell shaped curve. You know, that big rounded kind of hunched or humped curve. So phase one is the beginning of that curve. It's at the bottom. It is dysfunction. Typically pain is possible, but there's no changes on a radiograph. That's phase one. Then we're going to go to the top of that. Right. The middle of that bell shaped curve. Phase two is called unstable. There's early changes on radiograph and it's often localized low back pain and pain with movement. This is when we look at those seven features, the more of these that you see there, there's going to be what they're calling unstable, not unstable in terms of the person needing a spinal fusion. That's just what they're classifying it as, as phase two being unstable. Early disc changes on radiograph. Look at those seven features. It's probably going to be pain there. Then as you slide down the backside of that bell shaped curve, there's phase three, which is stabilization. And this is when things start to almost. If you don't think about it as auto fusion, there's minimal pain, there's osteophyte formation and there's a complete loss of disc height. So people traverse through that as time goes on. If the more of those features that they have in the early stages it highly correlates to pain. So keep those things in mind as you check out and look at MRIs this week in your practice. I think that's gonna be some very valuable information for you. If you have any questions about that. You know I used to overread 15 to 25 Mrs. And CTs per day at one of the orthopedic groups I practiced with. So if you have any questions on, fire me over an email. Jeffevidencebasedchiropractor.com Additionally, I just wanna say thank you for listening. Any feedback, please give it on itunes. Hit me up Jeff the Evidence Based Chiropractor. I'm happy to address anything. If you have future topics you wanna hear about, let me know. Any featured guests that you wanna hear about also let me know that. But thanks a ton for listening. I really really appreciate it. If you wanna see anything else that we have going on, you can visit the evidencebasedchiropractor.com over there. We have office postcards reactivation for your clinic that look awesome and have kind of timeless Hippocrates quotes and Edison quotes. So we have some really cool stuff over there and certainly if you want to bridge the gap and reach out to other healthcare providers in your community, I'd welcome you to come on board at the Evidence Based Chiropractor. Nobody's done it longer, nobody's done it better. And we've worked with hundreds if not thousands of docs at this point in time helping them get their MD referrals up. So if you are interested in that whatsoever, and if you are a practicing doc, I think you should be, check us out@the evidencebasedchiropractor.com I hope you have a fantastic week in practice and I will talk to you soon.

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