INFORMATION FOR ATTORNEYS > Back To Newsletter List

Shaw Chiropractic
A Medical-Legal Newsletter for Personal Injury Attorneys
by Dr. Steven W. Shaw

Do Abnormal MRI Findings Support Your Client’s Case?

In practice we are frequently questioned by the plaintiff attorney if a Magnetic Resonance Imaging study (MRI) would be helpful to further document their client’s injuries. The answer is not as simple as a yes or no. In this newsletter I will discuss both the strength and weakness of MRI imaging when applied to the personal injury patient.

First let me address the medical necessity issues faced by physicians when ordering specialty studies such as MRI. Medical ethics (as well as insurance company guidelines) require that a physician order tests only when medically necessary for the diagnosis and/or management of a patient’s injury or illness. Therefore, the clinical needs of the patient rather than the documentation needs of the case are the determining factor when considering the option of ordering sophisticated and expensive imaging studies. A physician should not order an MRI just because it may help the case or to increase the medical specials.

After medical necessity issues are addressed there are additional factors which need to be considered by the treating physician when determining if an MRI will be helpful. Not the least of which is the current research which suggests that an incredibly large percentage of asymptomatic patients will have abnormal MRI findings. This current research in the hands of an experienced defense lawyer or adjustor can destroy your argument on behalf of your client. Two such studies are summarized below.

Abnormal Magnetic-Resonance Scans of the Cervical Spine in Asymptomatic Subjects S. Boden, P. McGowin, D. Davis, T Dina, A. Mark and S. Weisel. Journal of Bone and Joint Surgery 1990:

In this study the authors found that 14% of subjects under 40 and 28% of subjects over 40 demonstrated abnormalities. Of the subjects under 40 10% had herniated cervical discs and 4% had foraminal stenosis. The over 40 group demonstrated 5% herniated cervical discs, 3% bulging discs and 20% foarminal stenosis. Disc narrowing, disc degeneration and cord compression were also recorded in 25% of the subjects under forty and nearly 60% of those over 40.

Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain M. Jensen, M Brandt, N. Obuchowski, M. Modic, D. Malkasian, J. Ross. The New England Journal of Medicine, Volume 331, Number 2, July 14, 1994

This study evaluated 98 asymptomatic people by MRI and interpreted the studies by two neuroradiologists who were blinded from patient history. The results revealed that 52% had bulges, 27% had protrusions and 1% had extrusions. 64 percent had disc abnormalities and 38% had abnormalities at greater than 1 level. Only 36% had normal discs at all lumbar levels.

Other studies on asymptomatic patients have demonstrated 39% disc protrusions (Weisel 1984 Spine), 20-36% disc protrusions (Boden,1990 J. Bone Joint Surgery), 54% bulge or herniation (Weinrob 1989, Radiology). Many other studies confirm these findings.

With this data on hand what should the plaintiff (or defense) attorney look for when determining the value of the case? In the Shaw Chiropractic Offices we look for the following during our case reviews. We believe an attorney should do the same.

1. Do the medical records justify the need for an MRI? (Referred pain, not responsive to conservative efforts, progressive neurologic deficits, discogenic syptomatology, etc)
2. Do the MRI findings correlate with the patient’s symptomatology?
3. Did the treating physician consider the imaging results and did the physician modify patient management?
4. Do the medical records make sense and document in a reasonable fashion the probability of a causal relationship between the trauma and MRI findings?
5. How might the abnormal findings functionally effect the patient’s future home and work activities?

If your treating physician has not addressed both the medical and legal issues above they have dropped the ball. When accepting responsibility for the management of an injured patient the attending physician must assume that they will be called upon to justify his treatment to his peers, insurance carriers and to those involved in the legal system. The next time you review your client’s file look for potential holes in the medical management and notify the physician early on so that they can correct any potential sources of embarrassment. On the other hand, a better approach may be to assist your clients in selecting physicians who are experienced both from a medical and legal perspective.

Copies of the articles used in this newsletter are available upon request. Call the local chiropractic office below or 1-800-232-OUCH