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  • Writer's pictureDr Josh Bonine DC

Disc Herniation MISSED by Medical Radiologist

Disc Herniation MISSED by Medical Radiologist

2009 - Research conducted at Dartmouth Medical School, Department of Orthopedics

In a VERY recent publication in SPINE, Lurie, Doman, Spratt, Tosteson, & Weinstein (2009) sought “To compare the interpretation of lumbar spine magnetic resonance imaging (MRIs) by clinical spine specialists and radiologists in patients with lumbar disc herniation” (p. 701). The goal of this study was to determine whether the standardized guidelines for the description of disc pathology where being following in clinical practice. In other words, was the information being transferred from the academic world to the clinical arena?

“The Spine Patient Outcomes Research Trial (SPORT) is a clinical trial with both randomized and observational cohorts conducted at 13 sites with multidisciplinary spine practices across 11 states. Using patients with disc herniation from the randomized cohort of this study, we compared the interpretation of a radiologist and a clinician reading the same image” (Lurie et al., 2009, p. 701).

The results of this study showed the following:

  1. “…the specific morphology of the herniation was not reported by the radiologist in 42.2% of cases” (Lurie et al., 2009, p. 703).

  2. “…the radiology dictation did not provide enough detail to classify the herniation as a protrusion, extrusion, or sequestered fragment” (Lurie et al., 2009, p. 704).

The authors have made the following recommendations regarding interpretation of spine MRI:

  1. “Transitional vertebrae may lead to confusion between vertebral levels” (Lurie et al., 2009, p. 705).

  2. “Disc morphology should be described as per the guidelines….” (Lurie et al., 2009, p. 705).

  3. Also, left/right confusion must be considered a potential reason for discrepancy between lateralization of clinical symptoms and lateralization of a herniation on a radiology report” (Lurie et al., 2009, p. 705).

It is critically important to work with clinicians who have extensive knowledge in the interpretation of spine MRI when representing the traumatically injured. Clinicians who read their own films and do not rely on the interpretation of the radiologist ensure the proper diagnosis, prognosis and triaging of those that have sustained a traumatic injury.


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Lurie, J. D., Doman, D. M., Spratt, K. F., Tosteson, A. N. A., & Weinstein, J. N. (2009). Magnetic resonance imaging interpretation in patients with symptomatic lumbar spine disc herniations. Spine, 34(7), 701-705.



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