Dangers of Accepting "Normal" X-Rays in Differential Diagnosis

[nopain]

I came across an interesting case study (Interesting to me anyways) about Acute Cervical Spine Injury and relying on X-Ray findings as the sole diagnostic tool.

This is an excerpt from a book called "Neruological Differential Diagnosis" by John Patten.

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Case Report Acute Cervical Disc Lesions

A 6'6" tall basketball playing student was involved in a fracas with gate crashers at his sister's birthday party and was severely beaten up by six soldiers. He subsequently suffered neck and arm pain and was seen at a hospital on several occasions and told that because his pain neck x-rays were normal there was no dramatic lesion. He presented two years later unable to continue playing basketball because of an insidiously evil and spastic paraparesis and evidence of bilateral C7 root lesions.

Myelography revealed a severe traumatic C6/7 disc lesion which required surgery. The root pain was relieved, but recovery from the cord damage was incomplete. This case exemplifies once again the dangers of accepting that normal x-rays indicate there is no abnormality.

Where a neck injury occurs in a patient who already has an abnormal neck due to cervical spondylosis. In such patients sudden flexion or extension of the neck following a simple trip or rear end collision in a car they produce acute root symptoms or even a cute cord damage. Usually the root symptoms are bilateral may affect multiple routes and the accompanying cord damage may cause an acute tetraparesis. The potential seriousness of even minor traumatic events affecting the cervical spine in this way in patients with severe pre-existing spondylosis must be recognized.

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I have been told numerous times by Physicians that I did NOT need an MRI. Because I have no insurance I insisted on the MRI and was able to get the prescription. How many times are the insured being denied this technology to save money for the insurance company? Doctors are penalized if they order too many tests depending on the insurance plan. Doctors are under a lot of pressure to not order expensive tests. If the test shows no additional pathology then it is an expensive waste... or is it? Another of many challenges the patient must endure.

[dshobbies]

In my opinion not ordering appropriate tests is malpractice. HMOs may be exempt from bringing suit but doctors are not. Pain and suffering is a causable action even if a delay of years hasn't resulted in additional damage. I'm not advocating sueing every time a test is not ordered but isn't the first line of the hypocritic oath "First do no harm"? Oops, was that a Freudian slip?