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| From early 2007 I will be providing a diagnostic and therapeutic management service to patients with low back pain and related problems, based in Bristol. Treatment of spinal problems is frequently of very poor quality. I meet many patients who have seen several "practitioners" and received several different diagnoses, and frequently patients who have spent hundreds of pounds on manipulative therapy without anyn benefit. NHS specialist spinal clinics such as we have at Frenchay Hospital in Bristol provide excellent assessment, diagnosis, and treatment, however waiting lists are long at every stage. Research shows that delay in provision of appropriate help for patients with back pain is associated with poor results, in terms of return to normal activities and fitness. Patients will receive: - Comprehensive clinical assessment - Radiological investigations with high quality MRI scanning when appropriate - Diagnosis, advice and treatment plan based on "evidence based practice" - Comprehensive professional report to the patient's General Practitioner, including any suitable recommendations for referral within the NHS. - A copy of the report - My liason with a Spinal Surgeon, Pain Consultant or other medical professional when necessary - Fast-track referral to one of the above or to a physical therapist as appropriate | BACK PAIN AND MRI SCANNING The image above shows a high quality lumbar spine (lower back) MRI scan, in a patient with back pain. The image is presented as though the patient were standing facing to the left side of the screen. The second lowest intervertebral disc (a dark horizontal band) has been subject to significant "wear and tear", and the lowest disc is mildly affected. Simple X-rays also show "wear and tear" but in much less detail. This is usually termed "degeneration" by medical professionals, and unfortunately sufferers do not often receive a clear explanation of the findings and the relationship to pain and any other symptoms. For instance, 50% of adults in their mid-thirties and older will have "degenerative" changes in their spine, whether or not they have back pain. Many practitioners take X-rays of patients spines without good reason. The Royal College of Radiologists advises against the use of X-rays outside of specific problems, for instance trauma with possible fracture. FACTS: ------------------------------- ONE LOWER BACK X-RAY EXAMINATION PRODUCES AS MUCH EXPOSURE TO IONISING RADIATION AS 120 CHEST X-RAYS. X-RAYS IN GENERAL CANNOT BE RELIED UPON TO SHOW MALIGNANT DISEASE OR OTHER SERIOUS CONDITIONS. ------------------------------- MRI SCANS DO NOT INVOLVE EXPOSURE TO IONISING RADIATION AND ARE HIGHLY RELIABLE IN DETECTION OF SERIOUS DISEASE AS WELL AS COMMON ORTHOPAEDIC CONDITIONS. ------------------------------- ADVICE: IF ANY PRACTITIONER SUGGESTS THAT YOU HAVE A SPINAL X-RAY, ASK IF THE REASON FALLS WITHING THE R.C.R. GUIDELINES, OR CONSULT YOUR FAMILY DOCTOR BEFORE PROCEEDING. | |||||
| Keith Greenfield PhD MCSP SRP SpineOnline Bristol Email:kg@spineonline.co.uk Copyright © Keith Greenfield PhD MCSP SRP 2008 | ||||||
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