Diagnostic imaging – whether it be X-rays, CT or MRI can significantly improve patient care and give us information that can aid in recovery. When it comes to X-rays, there is some evidence that misuse of the service occurs, whether it be overuse or under-use. It is for this reason that the Chiropractic College of Radiologists (Canada) created evidence-based Diagnostic Imaging Guidelines to be used by chiropractors and other health care professionals.
With respect to the low back and mid-back, the guidelines state that diagnostic imaging is required in the following circumstances:
- Mid-back or low back blunt trauma or acute injuries.
- High-risk screening criteria for spinal injuries such as mid-line tenderness of the spine with palpation, altered consciousness or neurological problems.
- Major trauma including pelvic trauma accompanied by inability to bear weight.
- When spinal stenosis (narrowing of the canal the spinal cord or nerves run through) or other degenerative problems are suspected.
- Lack of improvement with treatment, or worsening of the condition.
- Presence of red flags – suspected underlying disease, infection or cancer, etc.
With respect to the neck, the guidelines state that diagnostic imaging is required under the following circumstances:
- Acute neck trauma in someone who is older than 65, reports a dangerous mechanism of injury OR has numbness/tingling/weakness in their arms.
- Non-traumatic neck pain WITH pain/numbness/tingling or weakness in arms.
- Lack of improvement with treatment, or worsening of the condition.
- Presence of red flags – suspected underlying disease, infection, cancer, instability of the neck, etc.
It should be noted that these guidelines do not recommend taking an X-ray of every patient who walks though the door. A large number of people have simple mechanical spine pain for which further imaging is not needed, thereby sparing the patient radiation exposure and the health care system more expense. However, there are some cases (as listed above) where it is prudent to get further investigation before proceeding with treatment. Your chiropractor is trained to be able to recognize when you warrant further diagnostic imaging.
A full copy of the diagnostic imaging guidelines for the spine can be found below.
Dr. Debbie Wright is a practicing Vancouver Chiropractor.