Over the years, scholars and experts have observed a correlation between the increase in health care overheads and the high pervasiveness of neck and low back pain (LBP) in the fast growing population worldwide. Although spinal imaging may have significant benefits of identifying less common causes of low back pain and neck, imaging services’ misuse and overuse, an occurrence that has been widely noticed, contain adverse effects on individuals.
After obtaining of the first spinal x-rays in the United States of America in 1910, Chiropractic Techniques have since then employed spinal radiology with the aim of detecting and measuring spinal subluxation. Different studies have indicated that the idea of chiropractors in specializing in musculoskeletal disorders management remains to be the best, effective and safe approach, similar to the traditional back pain physiotherapy and medical care. However, studies have demonstrated knowledge practice gaps in different health care practitioners in red flags assessment alongside the use of diagnostic imaging. In addition, misuse and overuse of imaging services for spinal implications have increased in chiropractic and medical practice. Practically, overuse and misuse of imaging causes unnecessary procedures and tests that are linked to increased risks and side effects.
Use of Radiography in Chiropractic
Name: Patrick K. Kimuyu
Over the years, scholars and experts have observed a correlation between the increase in health care overheads and the high pervasiveness of neck and low back pain (LBP) in the fast growing population worldwide. Although spinal imaging may have significant benefits of identifying less common causes of low back pain and neck, imaging services’ misuse and overuse, an occurrence that has been widely noticed, contain adverse effects on individuals. After obtaining of the first spinal x-rays in the United States of America in 1910, Chiropractic Techniques have since then employed spinal radiology with the aim of detecting and measuring spinal subluxation1. Different studies have indicated that the idea of chiropractors in specializing in musculoskeletal disorders management remains to be the best, effective and safe approach, similar to the traditional back pain physiotherapy and medical care. However, studies have demonstrated knowledge practice gaps in different health care practitioners in red flags assessment alongside the use of diagnostic imaging. In addition, misuse and overuse of imaging services for spinal implications have increased in chiropractic and medical practice. Practically, overuse and misuse of imaging causes unnecessary procedures and tests that are linked to increased risks and side effects.
Some of the adverse effects of routine full-spine imaging include inefficient and inappropriate diagnosis and treatment, unnecessary exposure to radiation, added costs and even poor utilization of resources. The opponents of this practice claim that that this practice fails to describe spinal subluxation adequately, and there is a lack of reliability for geometric line drawing methods in spinal radiographs. They note that routine full-spine imaging increases cancer risks and that it is inefficient in improving patient outcomes. Therefore, this essay demonstrates why routine full-spine imaging is not beneficial in chiropractic practice.
Taylor and Bussieres affirm that routine full-spine imaging is quite unnecessary during the early lower back pain or neck pain patients’ evaluation1. Conversely, they proceed to state that it can only be necessary when there are certain clinical indicators reminiscent of red flags or serious underlying conditions. As a result, when these red flags are not present, it is renowned that lumbar spine radiography will seldom make known the patient’s complaint source, alongside failing to improve the overall clinical outcomes especially when compared with the normal clinical care that does not use immediate imaging1. In other words, both short and long term life quality of the patient, mental health, pain and function, along with his or her overall body health improvement will not be observed.
Several chiropractic radiographic analysis methods emphasize on the importance of assessing a patient in a vertical or weight-bearing position, an aspect that facilitates full spine evaluation and that of the regional posture. However, this process has erupted significance criticism in terms of validity, reliability and clinical relevance. Reliability refers to measurement repeatability, indicating consistency and precision after a certain procedure has been performed by distinct examiners at several occurrences2. The potential reliability of the spinal radiographic analysis is principally weighted by the positioning of the patient, anatomic variants, as well as the x-ray equipment. Furthermore, random measurement error and other systemic error sources negatively affect the measurement methods reliability. In this sense, the marking of radiographs for spinal misalignments or subluxations especially due natural and normal asymmetries impact within the human body on these measurements has not been established3. Therefore, it is clear that spine radiograph should not be used in chiropractic because, even though there is a demonstration of the inter-examiner reliability of the definite x-ray marking, reliability of the whole procedure has not yet been developed.[1] Although construct validity has already been evaluated, the predictive validity, which is responsible for identification of the current spinal complications, prediction of future occurrences and resolution measurement, is yet to be established in well-designed clinical attempts3.
Significantly, several chiropractic researchers have criticized this approach and accused it as being physiologically and anatomically flawed as many chiropractors believe that any change in the spinal curvature is abnormal and will have symptoms. They proceed to argue that chiropractors have failed to prove that this model can produce meaningful outcomes to patients, establish the biological plausibility of an ideal spine and demonstrate that their diagnostic tests facilitate better management of the patients4.
Notably, routine full-spine imaging is not important in chiropractic practice since the advocates of this model have failed to validate this routine use of x-rays in measuring spinal displacement. As a consequence, the failure of linking this spinal displacement with clinical conditions, a phenomenon that is described by an assemblage of assessable and pertinent symptoms and signs, has made the analysis of spinal displacement vulnerable to false diagnoses4. According to scholars, this technique represents the least sensitive of all the imaging modalities on the basis of establishing the patient’s symptoms, and may suggest false leads, not to mention that it has high probability of providing false reassurance5. Therefore, this condition has the potential of placing patients at high risks, not only from the unnecessary ionization or radiation exposure, but even from needless treatment of spinal curvature alternation and benign segmental displacement. Bartleson and Deen argue that routine full-spine imaging has the potential of exposing the patient to ionizing radiation, an incidence that has to be avoided at any given cost in pregnant women as it affects both the mother’s health and the fetus5.
Evidently, in order to achieve a state of structural as well as functional balance, majority of the chiropractors have adhered to a patient care philosophy that is aimed at treating the entire spine. On the contrary, this ideology has not been supported in the current medical evidence as corrective upper thoracic mobilization and that of the cervical regions is normally achieved by a dynamic 3-day manual course of therapy with a single procedure to the lumbar region. Thus, this practice of full-spine appliance has to be ascertained on case-by-case grounds with a accommodating clinical sense, rather than being routine6.
To sum up, although the proponents of routine imagining claim that it has diverse benefits such as revealing underlying issues of concern, allowing better care, providing useful information with less exposure to ionizing radiation and contains less cost compared to other forms of imaging, it has much disadvantages in the health care fraternity. Routine imaging of patients who have low back pain or neck pain, presenting with no red flags has over the years in larger health care field been confirmed to elevate harm and cost without showing significant outcomes in the affected. On top of the direct expenditures that occur during radiographs, indirect costs have been observed in incidental image findings as the practitioner tries to articulate the nature of the finding further. Again, routine full-spine imaging exposes the individual to low levels of potentially detrimental radiation.
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- PATRICK KIMUYU (Author), 2016, The Use of Radiography in Chiropractic Care, Munich, GRIN Verlag, https://www.grin.com/document/381345
