Paternalism in Radiology?

R.T Fitzgerald

doi:10.3174/ajnr.a3438

Abstract

Highlights

I read with great interest the article “Vertebral Endplate Changes Are Not Associated with Chronic Low Back Pain among Southern European Subjects: A Case Control Study” by Kovacs et al.[1]
The authors state, “In the case of vertebral endplate changes, refraining from including this finding in radiologic reports or mentioning it as a finding that is associated with disk degeneration but is likely to be clinically irrelevant may be a way of protecting patients from unnecessarily aggressive forms of treatment or overtreatment.”
Are the data strong enough to support the authors’ view? This opinion, potentially stemming from the personal experience of the authors and well-publicized articles examining the overuse of spinal fusion surgery,[2] merits further examination and raises a general question on the role of paternalism in radiology

Summary

Introduction

I read with great interest the article “Vertebral Endplate Changes Are Not Associated with Chronic Low Back Pain among Southern European Subjects: A Case Control Study” by Kovacs et al.[1] Their article demonstrates the challenges we face when attempting to correlate imaging findings with clinical symptoms in patients with back pain. The authors state, “In the case of vertebral endplate changes, refraining from including this finding in radiologic reports or mentioning it as a finding that is associated with disk degeneration but is likely to be clinically irrelevant may be a way of protecting patients from unnecessarily aggressive forms of treatment or overtreatment.” Are the data strong enough to support the authors’ view?

Results

Conclusion