Sunday, July 31, 2011
Abnormal CT Scans in Asymptomatic People: A Classic Revisited With Dr. Sam Wiesel
The motivation for this article occurred when we began to switch from using myelograms to CAT Scans. As this occurred, it became very easy to order diagnostic tests of the spine without being invasive. We began to see a lot of pathology without the appropriate history and physical findings which in many instances led to unnecessary surgery. Thus the question arose – were there individuals who had significant compression of the neural elements in the lumbar spine on a CAT Scan who did not have any symptoms?
The results demonstrated without doubt that people of all ages could have definite compression of the neural elements whether it be a herniated disc, spinal stenosis, or a combination of both without demonstrating symptoms. The message was and is: you need to treat the patient and not the test. This certainly holds true today and was validated when the same type of study was run using MRI’s with the same results – significant compression of the neural elements can occur in asymptomatic people. Thus, I will close by repeating that the physician needs to correlate the patient’s history and physical findings with the diagnostic tests before deciding on any type of treatment.