The diagnosis of internal disc disruption requires a positive discogram and concordant pain. Early discography is no substitute for MRI, because it is invasive. Most of the time imaging studies do not change the course of care, so cost-effective imaging requires not ordering the image unless it is likely to change the course of care. A Canadian doctor commented that advanced imaging is primarily a pre-operative test in Canada. On the other hand, there is still something weird about these grand rounds, or perhaps, the real world of back care they represent.
Simple referrals predominate.
Grand rounds at the ABS underscores the fact that the back business remains quite discordant. Even here, where all the participants are on their best behavior to be respectful, mindful, and appreciative of all the other professions represented, the practitioners almost always recommend the treatment they happen to customarily offer. The two panelists least likely to recommend their forte are the surgeon and the chiropractor, certainly their only point of commonality. I am reasonably certain that most of us, deep down, are arrogant enough to expect success even where the previous chiropractor has failed, thanks to our own special tricks of the trade. In all honesty, when I sit there during grand rounds, furiously typing away on some little computer-thing, it is impossible not to cast myself in the role of the chiropractor on the panel.