Spine MRI Medical second opinion. Treat MRI or patient? Dr. Anton Titov, MD. Up to 40% of asymptomatic patients have changes on spine MRI images that can be considered "surgical". Yet they have no signs or symptoms of vertebral column disease. Spine MRI abnormality requires medical second opinion by experienced spine surgeon. Do not get just a medical second opinion by MRI specialist. Leading spine surgeon discusses why it is important to evaluate spine MRI findings together with patient's symptoms and with results of clinical examination. Spine MRI Medical second opinion. Treat MRI or patient? Dr. Anton Titov, MD. Video interview with leading expert in spine surgery. Medical second opinion confirms that degenerative disc disease or spinal stenosis diagnosis is correct and complete. Medical second opinion also helps to choose the best treatment for slipped disk problem and spinal stenosis. Any abnormality requires spine MRI medical second opinion. Should surgeon treat MRI or patient? Dr. Anton Titov, MD. Seek medical second opinion on back pain and be confident that your treatment is the best. 40 percent of asymptomatic patients have MRI findings that can be interpreted as indication for surgery. It is important to treat patient, not just MRI radiographic finding. Only experienced surgeon can provide a spine MRI medical second opinion. Spine surgeon must decide, whether to treat MRI or patient? Dr. Anton Titov, MD. Surgery can be considered when all three factors are true. #1: patient has the clinical symptoms of spine problem slipped disc herniation, spinal stenosis, persistent back pain. #2: back lumbar MRI or neck MRI shows compression of spinal cord or degenerative disease process. #3: Patient did not respond to initial non-surgical therapy. MRI findings should not be treated in isolation. Patient's symptoms should be considered together with MRI findings. Medical second opinion of spine surgeon is preferred to medical second opinion of radiologist. patients seek spine MRI medical second opinion too little. They should ask a spine surgeon: do you treat MRI or patient? Dr. Anton Titov, MD. Abnormal lumbar MRI Medical second opinion. Abnormal cervical spine MRI Medical second opinion. Dr. Anton Titov, MD. The old surgical adage says. Do not treat the radiographic findings - treat the patient. Many patients have certain cervical disease on MRI but nevertheless would experience some limited symptoms. How do you decide in your practice whether to proceed to surgical treatment or to keep treating patient conservatively? Dr. Anton Titov, MD. Dr. Eric Woodard, MD. Spine neurosurgeon, Boston; former Chief of Spine Surgery, BWH, Harvard Medical School. That is correct. The decision to move toward surgery is a combination of three things. #1: the clinical symptoms that the patient is reporting. #2: the radiographic findings . This show the appropriate compression and / or appropriate disease process from a descriptive fashion. #3: response to initial non-surgical therapy. When those three factors are combined to indicate that surgery is superior than continuing with conservative factors, then surgery is appropriate. Dr. Anton Titov, MD. You are exactly correct in saying that the radiograph alone does not indicate surgery. In fact, some doctors have have studied this. Study showed that in the lumbar spine up to 40% percent of asymptomatic patients have radiographic findings that on some level could be considered surgical. you have to have a combination of appropriate symptoms, appropriate radiographic findings and appropriate failure of conservative treatment. Dr. Anton Titov, MD. This seems to be a recurring topic in orthopedic surgery. Dr. Eric Woodard, MD. I am aware of the study in Finland, when somebody for knee ligament injury and meniscus injury compared the sham fake surgery surgery versus the real surgery to repair the knee ligaments. One year later patients in both arms of the study wanted to do the same type of surgery that they had. that included the patients who had sham fake surgery done on their knee as well. Dr. Eric Woodard, MD. The placebo effect can be very powerful, yes. Spine MRI Medical second opinion. Treat MRI or patient? Dr. Anton Titov, MD. Video interview with leading spine surgeon. Do surgery based on MRI results in absence of symptoms?