Discussion
The important soft issue information including the morphology of the IVD structural pathology, is an essential component of a bio-mechanical imaging analysis, required for applying the specific closed decompression protocol in complicated discopathies.
There is no doubt that the MRI study diagnostic information provides an essential and non-replaceable component in DPPP-SAA, and similar protocols. Simultaneously, its limitations must also be well understood and compensated for by appropriate complementary imaging studies.
It is also important to note that achieving symptomatic relief in advanced cases of IVD structural pathology is not adequate, and improvement of structural pathology itself must also be documented.
This is particularly important in the presence of instabilities of the functional unit, in particular the posterior compartment.
It should also be reiterated that the level of stability does not necessarily correlate with the extent of discopathies, and a motor unit must be evaluated in its entirety.
As we repeatedly emphasize the importance of motor unit stability not only in function but also in structure, the importance of complementary stress studies has become more clear, as has been demonstrated in this particular case.
Effective treatment protocol requires an accurate final diagnosis, structured by bio-mechanical diagnosis, bio-mechanical imaging analysis, correlated with appropriate diagnostic imaging studies.
Requesting an imaging study in general must have a clinical objective in mind, clearly communicated to the radiologist / neuro-radiologist. As such, all imaging requests must include the working diagnosis, and in some cases, a short history as required.
Failure to apply evidenced-based clinical practice guidelines can lead to delayed or mis-diagnosis even in relatively simple cases such as this.
Reaching a working diagnosis as a prerequisite to a final diagnosis, is a knowledge-based deductive reasoning process, not a lucky clinical guess.
Discipline and consistency in our clinical practice procedures can help to reduce mis-diagnosis / delayed diagnosis, resulting in more favorable treatment outcome.
H. Sabbagh, D.C.
Published: August 25, 2023
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