Last year I got sick on the fourth day of the ECR. Between lunchtime and dinner I came down with a flu ? not a funny cold, but a real flu. Intelligent as I was, I packed my 30-kilo suitcase immediately, left out the bare essentials, and went to bed in my hotel. That was a good idea because I couldn't have packed the suitcase two days later, when I drowsily left for the airport drugged to my gills.
Arriving at home I went straight to bed again and stayed there for another three days, feeling moribund as all sick men do in such cases. On day five I tried to get up, but excruciating pains stopped me. I could hardly walk: something had moved between L5 and S1.
What do you do as a man, physician, and radiologist in such a case?
First, you return to bed and feel pity for yourself. Then you ask the commiserating cleaning lady what she would recommend in your case. Then you make a preliminary diagnosis and decide that anti-inflammatory drugs and avoidance of any medical help would be the best. This is when you remember that you have preached that radiological examinations, particularly MR imaging, are of no use in cases when patients can still move, there is no paresis, and surgical treatment is not imminent.
Which takes us to the Wilhelm Conrad Roentgen Honorary Lecture by Adrian K. Dixon of Cambridge University, which dealt with "Imaging of the lumbar spine: why, when and how?"
Dixon pointed out that imaging of the lumbar spine remains complicated despite the amazing advances in CT and MRI. Plain radiographs confer little or no benefit because they cannot reliably demonstrate any of the key disorders of the lumbar spine — disc herniation, disc space infection, spinal stenosis, malignancy, or osteoporosis. CT has largely been superseded by MR imaging, although CT remains the gold standard for density measurements and fractures. MR imaging is the optimal imaging investigation for nearly all lumbar spine lesions.
However, the real questions relate to the indications for and timing of imaging. Few studies have shown that lumbar spine MR imaging improves the patient's quality of life. Dixon asked and answered questions such as: Is MR imaging more useful for the clinician than the patient? Does an experienced clinician need the help of MR imaging in every patient with a back complaint? Or is MR imaging needed only as a road map before likely surgery? Can MR imaging speed up the assessment?
His answers confirmed my reactions as a suffering radiologist. (Anyhow, I had an MR examination six months after the fact to satisfy my curiosity.)
The opinions of other radiologists attending the session differed a little, depending on their medical environment, reimbursement, referring orthopedists, etc. However, all agreed that a conservative approach is the best ? or as one of them summarized it: I'd rather have a bottle in front of me than a frontal lobotomy.
See you in Vienna next year.