Are your MRI or x-ray results for lower back pain an incidentaloma?

What is an incidentaloma?

It is a radiological finding of dubious clinical significance.   In the past, incidentalomas (found by accident) were discovered in the lungs, kidneys, prostate, breast, and other parts of the body when your doctor ordered imaging of a body region.

Many of these were further investigated by doctors exposing patients to unneeded tests, costs, painful biopsies, and stress. Imagine after all that, you were just healthy and normal.

In some cases, patients were told they may have cancer or growth which was benign which may have resulted in treatment that caused a problem in an otherwise normal person.  Most incidentalomas are growths that are just part of the aging process and are totally normal.

Common incidentalomas are identified in breast tissue, lung tissue, and prostate which may have resulted in surgeries or other invasive procedures that may have disfigured the person or worse, left them with a lifelong problem such as incontinence.

Incidentalomas of the spine?

The term incidentaloma is now being used with MRI scans of the spine. Diagnostic tests of these regions have in the past been overutilized with those who suffer from sciatic pain, arm pain, and even neck pain.

Physicians are required to perform a detailed history and examination to determine the cause of your problem.  Many specialists would order x-rays and MRI scans for further diagnostic confirmation of why you have symptoms.  Surgeons regularly order these tests to see if they are a candidate for a medical procedure that is more invasive.  Primary doctors will order expensive MRI scans if you did not improve with therapy or medication or over time.  Some primary doctors in the past routinely ordered these tests as part of a normal diagnostic workup which is why insurance carriers now have most of these tests managed by third parties that prevent over-ordering of unnecessary costly tests.

A thorough history and examination always offer more useful information than an x-ray or an MRI.  In many cases, an x-ray offers little value unless there is trauma involved or if a problem is chronic.  Many provider groups have created best practice’s for their professions as a result which includes fewer x-rays or MRI scans.

Many MRIs show bulging discs, old herniations of discs, degenerative processes, and other findings that may or may not have closely correlated with the patient’s symptoms and exam findings.

Studies have shown that in the absence of pain, many people still show these same types of degenerative processes, bulges, and herniations which is why they are now being considered incidental. Is that finding on an MRI actually the reason you hurt?  Perhaps, you don’t need to know if the problem you have improves with appropriate care.

The concern is that just as in other types of incidentalomas, patients in pain may be recommended invasive and risky procedures when a chiropractor may have been a better choice for who the patient should have seen first. Unfortunately, patients in pain want relief and may be willing to have an invasive procedure out of desperation, when the best and safest solution is noninvasive and can take some time if the problem is long-standing.

So many patients have been worse off after back surgeries that permanently changed their spinal mechanics, but did not solve the patient’s problem which was back or neck pain. Many are in pain for the rest of their lives, which could have been avoided with the right approach and understanding of why they hurt. The classic failed back surgery syndrome is a result of relying on tests and not being able to properly evaluate, diagnose and treat a painful condition.

While it is true some patients do benefit from injections and less invasive spinal procedures, it is also true that most, with the help of a chiropractor, can avoid imaging such as an MRI which is the gateway to more aggressive approaches for spinal pain relief as well as incidentalomas. While these tests are very sensitive and informative, they are not necessarily going to show you why you are in pain and may open the door to more aggressive and potentially harmful medical procedures.

Shouldn’t you see a chiropractor first for neck pain, lower back pain, and sciatica?

Is your MRI showing a bulge or herniation that is not related to why you hurt?  If so, it is an incidentaloma of the spine. Perhaps this is why the Annals of Internal Medicine in February of 2017 recommended many of the methods employed by chiropractors first while recommending medication and invasive methods for pain relief of lower back pain last. What is concerning is that a recent University of Pittsburgh study found that almost half of medical patients received care that did not follow these scientific guidelines, resulting in them developing chronic lower back pain, a preventable consequence.   Insurers are taking notice as they have the data showing that people who see chiropractors first are much less likely to develop chronic lower back pain. This saves you and the healthcare system money while improving the quality of your life when you have the problem treated by the best provider for that problem.

In terms of lower back pain and lower back spinal conditions, chiropractors help people avoid unnecessary procedures, medications, and the development of chronic back pain if you visit them first. Chiropractors as growing evidence is now showing is the best provider for lower back pain and my other musculoskeletal conditions.

For back pain, sciatic pain, and neck pain, see a chiropractor first.  You can make your first appointment using this link.