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Disc Degeneration Not Abnormal?
If
you've been in practice for any length of time you have no doubt had a patient
ask to take their x-rays to their doctor in order to get a second opinion
about them and their problems. No doubt that in many cases the doctor has
told the patient that the degenerative changes evident on the radiographs
were "just a result of aging" and wasn't really anything abnormal.
Of course I will always just show the patient the x-ray again, point to the healthy looking disc just above or below the degenerated one and ask the patient how old each disc is. I enjoy the look in their eyes when it dawns on them that their doctor didn't seem to know this elementary fact. I once again explain to them that the degenerative changes are due to the presence of abnormal curvatures, abnormal alignment and any other pertinent findings in their case. I suspect the majority of chiropractors go through a similar routine.
Well, according to Dr. Jeffrey Jarvik and Richard Deyo we're wrong and "disc degeneration is simply an accompaniment to aging." This is according to an article titled Disc Degeneration Not an Abnormality-And Not a Diagnosis published in The Back Letter. (1) They review Jarvis' and Deyo's study published in the journal Radiology Clinics of North America. (2)
According to The Back Letter, "Disc degeneration is often termed an 'abnormality' but in reality it is a perfectly normal finding in populations beyond the age of 40. It is relatively common even among individuals in their 20's and 30's.
The Back Letter article goes on to quote Jarvis and Deyo "It may be a misnomer to term findings such as bulges, dehydration, and loss of disc height as abnormalities, since these imaging findings are clearly related to aging. Jarvis and Deyo might also surmise that age related tooth decay is normal!
From
our perspective as chiropractors it would seem ridiculous to think that focal
degeneration of a disc secondary to subluxation with it's concomitant effects
on disc neurology, mechanoreceptive feedback, posture, motion etc is not abnormal.
Perspective is the key word here.
For a different perspective lets look at a study presented at the Association of Chiropractic Colleges 2001 Conference titled Cervical Arthrosis: Influencing Factors of Biomechanical Stress, Location, Frequency, Age, and Gender within a Symptomatic Group. (3) Dr. Weigand et al at Logan College, in addition to gathering statistics simply on which levels were found to be degenerated based on age and sex, also looked at geometric and loading variables such as cervical curve angle, gravitational loading, C2 angles etc. They found that in 79% of the cases these geometric and loading variables allowed prediction of pathology.
Now what study do you think an IME doc or an HMO will use to deny care and services to patients? The point is that our profession needs to support more work like this that examines these relationships in such depth. As always I look forward to your feedback, suggestions and comments.
Dr. Matthew McCoy
Editor - Journal of Vertebral
Subluxation Research
References:
1. Disc Degeneration Not an Abnormality-And Not a Diagnosis. The Back Letter.
Volume 16, No. 2, 2001.
2. Jarvik JG, Deyo RA. Imaging of lumbar intervertebral disc degeneration
and aging, excluding disc herniations. Radiology Clinics of North America
2000; 38(6):1255-66
3. Weigand R, Kettner N, Brahee D. Cervical Arthrosis: Influencing Factors
of Biomechanical Stress, Location, Frequency, Age, and Gender within a Symptomatic
Group. Abstracts of ACC Proceedings. The Journal of Chiropractic Education,
Vol. 15, No. 1, 2001.
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