Using Medical Imaging to Make a Facet Disease Diagnosis

While it may seem counterintuitive to eschew medical imaging as a way to confirm a facet disease diagnosis, a recent report in the Annals of Internal Medicine by members of the clinical guidelines committee of the American College of Physicians (ACP) recommends just that for people who do not suffer from "severe or progressive neurologic deficits or are suspected of having a serious or specific underlying condition." The report's authors also recommend that a course of conservative therapy be attempted before medical imaging is performed.

What's Wrong With X-rays?

What, exactly, do the ACP's clinical guidelines committee members have against X-rays, MRIs, CT scans and the like? The answer is, they have nothing against medical imaging, outside of the potential harm of repeated exposure to radiation. What they object to most is what they conclude is an over-reliance on medical imaging by physicians practicing "defensive medicine" to avoid potential lawsuits and assuage patients who insist on knowing the precise cause of their neck or back pain. The committee also points out that medical imaging helps drive the high cost of treatment and diagnosis of conditions such as facet disease.

Should Medical Imaging Ever Be Used?

There are certain patients, the committee acknowledged, who do require medical imaging for such things as a facet disease diagnosis. These patients include those with major risk factors for cancer and spinal infections, as well as those suffering from signs of cauda equine syndrome, which is a potentially life-threatening condition involving compression of the nerves in the extreme lower portion of the spine. Another indication that an X-ray or MRI might be required, according to the committee, is the presence of chronic tingling, numbness, or muscle weakness often associated with severe spinal nerve compression.