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MRI ... Opened vs. Closed/Need Advice Please


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Old 01-01-2018, 11:23 AM   #1
CherylL24
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Question MRI ... Opened vs. Closed/Need Advice Please

Hello,

I've been experiencing a bilateral leg/ankle/foot problem for over 8 months now which has led me to be bedridden due to pain while walking/standing, etc. (I only spend about 5-10 minutes on my feet per day as the pain levels increase to a 9 whereas lying in bed in the fetal position give me a continuous pain level of 5)

I've had a plethora of testing done and the only abnormalities have been 2 EMG's which show a problem with L5/S1 and a set of lumbar x-rays that show mild narrowing of the lumbar L5/S1 region as well as bone spur formation.

The pain that I experience in my legs/ankles and feet follow the dermatomes of L5/S1, as well.

I saw an Ortho. Spinal surgeon who requested a lumbar MRI. His office called and set up the appt. for me at his office where the MRI was located. I had this done and it turned out normal. He insisted that my issues are not coming from my lumbar spine.

I have physicians within multiple specialties stating that it is. I was told by many of the physicians that open MRI's often miss things. When I brought up the open MRI (.3 tesla) vs. the 1.5 tesla closed MRI issue to the Ortho. Spinal surgeon, he became irate, stated that my lumbar area was fine and released me from his care.

What are chances of getting multiple lumbar x-rays showing narrowing and bone spur formation, yet having a lumbar open MRI that shows nothing?

Thanks in advance for your thoughts.

 
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Old 01-01-2018, 02:23 PM   #2
Harri3t
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Re: MRI.....Opened vs. Closed/Need Advice Please

I have always been told that closed MRI is more accurate than open. Beyond that, I see a disturbing ethical issue with being forced to use expensive physician owned testing equipment. No patient should be forced to use a doctor's own medical testing facility. You can never be sure if the test is actually necessary or the best ,most advanced type available, when tests may just be ordered to pay it off and maximize profits.

Where to have a test done should always be a matter of your own choice. Your area's medical ethics laws and policies may even require that. Choosing a unit that sees wider use over a larger area of practice such as at a hospital makes it less likely that it will be used inappropriately and that the equipment is as up to date as possible.

I avoid all physicians that try to force the use of their own equipment as a personal preference. And if they insist I am not afraid to ask for the test order and tell them I will schedule it myself and have it done elsewhere after getting an OK from my insurance.

 
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Old 01-02-2018, 08:12 AM   #3
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Re: MRI ... Opened vs. Closed/Need Advice Please

Did you get a copy of the MRI report? Doctors often say "everything is fine" when in fact there is some stenosis, or a small disc herniation. If they feel it doesn't require surgery at the time, some tend to downplay any issue that exists. Some spine surgeons are more interested in the patient's ongoing spine health and will follow a patient for years before they require surgery while some dismiss someone right away if they don't require surgery in the immediate future.

A prone, enclosed MRI is the most accurate. They can give you a mild tranquilizer if you are claustrophobic.

 
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Old 01-02-2018, 01:14 PM   #4
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Re: MRI.....Opened vs. Closed/Need Advice Please

[QUOTE=Harri3t;5475212]I have always been told that closed MRI is more accurate than open. Beyond that, I see a disturbing ethical issue with being forced to use expensive physician owned testing equipment. No patient should be forced to use a doctor's own medical testing facility. You can never be sure if the test is actually necessary or the best ,most advanced type available, when tests may just be ordered to pay it off and maximize profits.

Where to have a test done should always be a matter of your own choice. Your area's medical ethics laws and policies may even require that. Choosing a unit that sees wider use over a larger area of practice such as at a hospital makes it less likely that it will be used inappropriately and that the equipment is as up to date as possible.

I avoid all physicians that try to force the use of their own equipment as a personal preference. And if they insist I am not afraid to ask for the test order and tell them I will schedule it myself and have it done elsewhere after getting an OK from my insurance.[/QUOTE]

I did a lot of reading regarding open vs closed MRI's since I had that lumbar MRI and everything that I came across stated just as you did, closed are far superior to open.

As for ethics, I wholeheartedly agree. I would've preferred to go to a hospital of my choice but wasn't given that option. I looked up the model in his office and it's $100K, so I'm sure that unit was paid off long ago and now it's pure profit.

Now, I'm sort of in a jam because I need another lumbar MRI but my insurance won't pay for another since I they already approved and paid for the open one that I had at his office. I wish I would've researched this prior to having the open MRI done, I wouldn't be in this predicament now.

Thanks for your thoughts.

Last edited by CherylL24; 01-02-2018 at 01:15 PM.

 
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Old 01-02-2018, 01:21 PM   #5
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Re: MRI ... Opened vs. Closed/Need Advice Please

[QUOTE=teteri66;5475247]Did you get a copy of the MRI report? Doctors often say "everything is fine" when in fact there is some stenosis, or a small disc herniation. If they feel it doesn't require surgery at the time, some tend to downplay any issue that exists. Some spine surgeons are more interested in the patient's ongoing spine health and will follow a patient for years before they require surgery while some dismiss someone right away if they don't require surgery in the immediate future.

A prone, enclosed MRI is the most accurate. They can give you a mild tranquilizer if you are claustrophobic.[/QUOTE]

I just called today to get a copy of the MRI itself and the report, as well.

I questioned him at my last appt. as to why the MRI showed nothing, while the x-ray showed mild stenosis and bone spurs. He seems agitated and didn't give me an answer.

Needless to say, I'm quite irate now because I need another MRI and I'll probably have to pay for one out of pocket since I doubt my insurance will cover another lumbar MRI. (His was in Nov.)

Furthermore, he told me that he would direct me where to go should my MRI turn out fine. Instead, I got a call from his secretary cancelling my next appt.! I can't walk at all. My days are spent in bed and am only on my feet about 5-10 minutes a day due to pain. Nice brush-off.

Thanks for your response.

 
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Old 01-03-2018, 07:45 AM   #6
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Re: MRI ... Opened vs. Closed/Need Advice Please

Well, clearly time to find a different spine surgeon! Before paying out of pocket for a new MRI, I would take the open MRI to a new spine doctor. I suspect, from everything you said, that it will show some stenosis, but it will be a small enough amount that it allowed the first doctor to say "everything is fine."

I really can't think of anything to suggest. It seems like the amount of pain you are experiencing does not match up to whatever the doctors have been able to find thus far.

I'm not sure what policies are right now covering frequency of MRIs, but a year or two ago, policy was that you could have one every six months...sooner if the doctor showed it was necessary.

 
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Old 01-03-2018, 07:54 AM   #7
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Re: MRI ... Opened vs. Closed/Need Advice Please

I'm not convinced your issues are coming from the spine. You've had both an orthopedic foot and ankle surgeon and a spine surgeon tell you everything looked fine, right? And your symptoms don't sound anything like most cervical or lumbar spine issues. Usually pain is not bilateral unless there is a spondylolisthesis...and it is odd to just have the only symptoms be below the knees in both legs.

Have you seen a nutritionist or a naturopathic doctor? The cramping etc. sound to me more like a vitamin deficiency or similar. The B vitamins in particular affect the central nervous system. This might be a better expenditure than a new MRI.

Last edited by teteri66; 01-03-2018 at 08:00 AM.

 
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Old 01-03-2018, 08:28 AM   #8
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Re: MRI ... Opened vs. Closed/Need Advice Please

[QUOTE=teteri66;5475311]I'm not convinced your issues are coming from the spine. You've had both an orthopedic foot and ankle surgeon and a spine surgeon tell you everything looked fine, right? And your symptoms don't sound anything like most cervical or lumbar spine issues. Usually pain is not bilateral unless there is a spondylolisthesis...and it is odd to just have the only symptoms be below the knees in both legs.

Have you seen a nutritionist or a naturopathic doctor? The cramping etc. sound to me more like a vitamin deficiency or similar. The B vitamins in particular affect the central nervous system. This might be a better expenditure than a new MRI.[/QUOTE]

I really don't know what to do at this point. I'm not receiving much guidance from any of the specialists that I've seen and seem to be on my own.

I've already seen a Rheumatologist, Vascular Surgeon, several Foot and Ankle Surgeons (who said it was coming from my back), several Podiatrists (who again said the back) and 3 Neurologists (who all said it was my back) and 1 Ortho spine doctor who said it wasn't.

Both EMG's that I've had done pointed to L5/S1. The one Neuro even mentioned how the nerves in my calves were firing even while at rest. So, the cramping in my calves is a nerve-related issue.

I've had much done in the way of blood work and various testing and all (including B vitamins) have come up normal. I have not seen a nutritionist, as I eat quite healthy and didn't see a reason for one at this juncture. As I'm sure you can imagine, it's quite difficult getting to appt.'s due to being bedridden at the moment, so I've been trying to pick and chose my appt.'s wisely.

With at least 10+ specialists pointing at my back, this is why I've focused my research on my back.

Were the EMG's that I had done incorrect?

Thanks.

Last edited by CherylL24; 01-03-2018 at 08:30 AM.

 
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Old 01-03-2018, 03:43 PM   #9
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Re: MRI ... Opened vs. Closed/Need Advice Please

The EMG is a subjective test...but, if it indicates damage at L5-S1, I would assume there is. So it would seem the only option is to look for a different spine surgeon.

 
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