Use of lumbar radiographs for the early diagnosis of low back pain. Proposed guidelines would increase utilization
The Agency for Health Care Policy and Research (AHCPR) has recently published guidelines for the management of patients with acute low back pain, which include recommendations for the use of lumbar radiographs, based on the identification of “red flags” for fractures, tumors, or infections.
It should be understood that the discogram is less about the anatomy of the disc (what the disc looks like) and more about its physiology (determining if the disc is painful). It is well known to discographers that a really abnormal looking disc may not be painful and a minimally disrupted disc may be associated with severe pain. It is impossible to definitively diagnose a painful disc without performing a discogram.
A CT scan, discogram and myelogram are completely different tests providing different information. The myelogram is better for identifying a pinched nerve that may be causing the sciatica. This is important if the pain is primarily in the legs or if there is any leg weakness with the leg numbness and tingling. A discogram is a provocative test that is designed to tell if the front of the disc space is still a cause of pain.
Even recent medical research provides evidence of the stigma of chronic pain. The news media recently reported the development of a machine that determines whether patients are telling the truth about how much back pain they have by recording how patients move and how much force they exert in various directions. Insurance companies are reportedly showing great interest in this new device (The Wall Street Journal, September 26,1989.)
“You don’t look like you’re in pain,” people tell Marty Heinrich, 39, of Damascus, MD. She asks them, “What does pain look like?” She has had chronic pain, originating with a broken back, since childhood.
Marty Heinrich visited her doctor after her second back surgery, still suffering from chronic back pain. “There’s nothing wrong with this fusion,” the doctor told her. “It’s a beautiful fusion. You need a psychiatrist.” She says that health care professionals have asked her, “Why are you hanging onto your pain?” or What’s the payoff you’re getting?”
“Doctors have treated me like a nut case,” Heirrich agrees. “It’s the most destructive thing.” She firmly believes that, in most cases, pain leads to depression, not vice versa.
Pain patients are speaking out more publicly and getting more publicity. On a local level, they are banding together in support groups to fortify each other. It is only a matter of time until this expanding vitality impacts the public consciousness to squelch the stigma of chronic pain.
TOKYO - An 89-year-old woman died after an ambulance crew spent two hours trying 30 hospitals before finding one that would accept her for treatment, Japanese officials said Friday.
Matsumoto said the other hospitals rejected the woman because they were full or their doctors were not immediately available to treat her.
Last year, a pregnant woman in western Japan died after being refused admission by about 20 hospitals that said they were full.
The latest case underscores Japan’s health care woes, in part created by a shortage of doctors in the country’s rapidly aging society. Critics say long working hours and a government policy change several years ago to keep the number of doctors down are to blame.
The minimally invasive anterior approach for spine fusion surgery is in many ways an ideal technique for gaining access to the disc space in the lumbar spine with minimal risks or unwanted after effects for the patient.
An interbody fusion is typically done two ways. The first way is through a posterior approach (from the back) and is called either a Posterior Lumbar Interbody Fusion (PLIF) or a Transforaminal Lumbar Interbody Fusion (TLIF). The other method is through an anterior approach (from the front) and is called an Anterior Lumbar Interbody Fusion (ALIF).
http://www.spine-health.com/topics/surg/miniant/miniant01.html