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Message: [QUOTE="Cuseregular, post: 367799, member: 185"] So I'm providing incorrect information on my own back experience? Umm, ok. And are you saying that from day one of injury the ortho dr. up there well regarded and highly experience should have picked this up? From day one? Now with respect to disc issues you've very subtlely changed the subject. We were talking about disc herniaton and not "disc degeneration" that you changed to. You're absolutely right that disc degenation is very easily diagnosed. A basic exam and eval. with a simple x-ray will show this no doubt. And with that in mind though, many people with this condition similarly are not symptomatic even though they have it... [url]http://www.folsomphysicaltherapy.com/imaging_of_lumbar_degenerative_disc_disease.pdf[/url] go right to the conclusion on page 23 Furthermore, these degenerative disc cases are also concommitant with disc hernations which complicates the clinical picture greatly. And no doubt you know that xrays are pretty much useless to show this part of the story (the internal aspect of the disc). So this is where MRI comes in to give us a definitive diagnosis that will help with treatment. I"d like to do them in all suspected cases of LBP due to disc displacements but as I'm sure you're aware, insurance issues make this a non starter and thus experience and, again, the nuance art/science and experience aspect of practice must lead us in Rx. This because of what you say is only sometimes true. At the risk of repeating myself not all disc herniation patients show characteristic symptome. For example, if they did show traditional symptoms, as you know, the herniated disc would be accompanied by certain characteristic and consistent physical findings as well as productive orthopedic testing. For example, a L5 herniation would be associated with an S1 reduced myotome (weak gastrocs, foot everters), dermatome changes (reduced or even loss of feeling over the side of the foot, dorso/lat calf), and reflex changes (loss of the ankle jerk). Similar circumstances with different anatomy for other disc levels in the spine. Problem is of course that often times all of this together isn't the case as I outlined in the post above. So we send them when we can for MRI and we still find some version of disc herniation but not to the point always of causing characteristic symptoms. This again to the unique variables and nuance involved. I'm certainly not providing innaccurate information rather just providing what is commonly known now among modern providers/clinicians and research professionals. Are all the following providing innaccurate information too? [url]http://home.comcast.net/~jasoncillo/Lumbar.pdf[/url] [url]http://www.acr.org/~/media/889E0EC394D642B6B2AF7379357B4E57.pdf[/url] [url]http://www.ncbi.nlm.nih.gov/pubmed/8208267[/url] [url]http://ukpmc.ac.uk/articles/PMC2465278//reload=0;jsessionid=uxwX4TagEcmfjoVpSMM7.6[/url] [url]http://www.alignthespinechicago.com/herniated-discssciatica/[/url] [url]http://longbeach.patch.com/groups/dr-sean-pastuchs-blog/p/bp--back-pain-its-probably-not-your-herniated-discs[/url] [url]http://www.rebuildyourback.com/herniated-disc/pain.php[/url] A couple on AVN and how hard it is to diagnose: [url]http://www.ncbi.nlm.nih.gov/pubmed/912968[/url] [url]http://emedicine.medscape.com/article/333364-clinical#showall[/url] [url]http://orthodoc.aaos.org/MarkKatzMD/AVNStrikesYoung.htm[/url] [/QUOTE]

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