Valuable Information for Orthopedic and Neurosurgeons-Juniper publishers
Juniper publishers-Journal of Head Neck
Research
Researchers from Johns Hopkins Hospital have published information which reports:
a. 40%-80% of chronic pain patients are misdiagnosed
[1-5] Most are told they have sprains and strains when they actually
have surgically correctable lesions [1,2,5]. For CRPS (RSD) 71%-80% of
patients really have nerve entrapment, which responded to peripheral
nerve decompression [3,4].
b. Doctors order the wrong tests and don’t spend
enough time taking a careful history. A Wall Street Journal article
quotes medical research which says the two leading causes of
misdiagnosis are
i. Ordering the wrong diagnostic test (57%) and
ii. Poor history taking (56%) [6].
c. MRIs miss damaged discs 76%-78% of the time, and CTs miss bony lesions detected by 3D-CT 56% of the time [7,8].
d. Once a thorough history is taken, and the proper
tests are ordered, 50%-63% of patients, previously told there is nothing
to be done to help them, require surgery to improve [1,2,5].
Don Long, MD, PhD, former chairman of neurosurgery
at Johns Hopkins Hospital reported about a group of 70 patients with
neck pain and headache, who, after having normal MRI, CT and X-rays, had
been told that nothing could be done to help their pain. These patients
then received facet blocks, root blocks, 3D-CT, flexion-extension
X-rays and provocative disco grams. As the results of these tests, 63%
of the patients were determined to be candidates for surgery. Post
operatively, 93% of the patients improved [5].
A team of physicians from Johns Hopkins Hospital
developed an Internet based questionnaire, which duplicates a physician
taking a careful and thorough history. When the patient finishes the
questionnaire, in either English or Spanish, called the Diagnostic
Paradigm, then within five minutes, diagnoses are generated, based on
the answers to the questions, which have a 96% correlation with
diagnoses of Johns Hopkins Hospital doctors [9]. Then, based on the
correct diagnosis, the Treatment Algorithm recommends the correct test
to use. The efficacy of this technique has been documented by the
ability of the Diagnostic Paradigm and Treatment Algorithm to predict
intra-operative finding with 100% accuracy [10].
What is meant by the correct test? Since the MRI is
not particularly accurate for diagnosing disc disease, other testing is
needed. Please refer to the article by Dr. Long again. At Johns Hopkins
Hospital the neurosurgeons used facet blocks, root blocks, provocative
disco grams, and peripheral nerve blocks to improve the accuracy of
diagnosis. These are interventional procedures, which require the use of
a C-arm fluoroscope, and can be performed by an anesthesiologist,
interventional radiologist, or a surgeon.
The tests are available at www.MarylandClinicalDiagnostics.com, and can increase income, and improve patient care.
These tests benefit the surgeon in various ways:
- Produce a more accurate evaluation in less time, with less inter-rater reliability issues.
- Get paid for the actual tests themselves, using CPT codes which have been used in the past. The average payment is $76 for both tests.
- See more patients in a day, since using the tests will allow a physician to evaluate a patient in 5 minutes instead of the normal 20-40 minutes.
- The Treatment Algorithm will recommend that a physician perform facet blocks, root blocks, peripheral nerve blocks, and provocative disco grams at a far higher level than they do now.
- The number of patients who will require surgery will increase 50%-63%.
Orthopedic and neurosurgeons using the tests report an
increase in income of at least 20 % a year without increasing
the time spent seeing patients, and produces better patient
satisfaction.
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