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 Clinical Considerations 

MRI diagnostic clinical validity 

(sophisticated, but still misleading, imaging).

The common misconception and abuse in detecting (diagnosing) and guiding treatment is a foolproof test (i.e. falsehood claimed accuracy of 25%-40%). However, the reliance of such "tests" is clinically false, because imaging of passive/static abnormalities is incompatible to active/dynamic physical examination and history taking findings, unless correlated accordingly.

Research showed that on 5.000 patients MRI tested, 75% displayed a variety of spinal disorders, but none were clinically symptomatic! Spine degeneration is normal in adults due to the fact that every adult's spine is deformed, thus becoming symptomatic or asymptomatic. Errors are due to non-specialistic care procedures, hence misrepresentation within correct integration of clinical examination.

Common factors are financial and non-specialistic. The most important is a history and physical examination, which can not be substituted by anything else. 99% of spinal disorders are mechanically based. Even evaluation of "sensitivity" of clinical diagnostic study (false negatives) and "specificity" (false positives) must be interpreted truly. Accordingly, the MRI ratio has shown a significant false/positive ratio in asymptomatic people with a variety of abnormalities in over 20% and over 40% of people over 40. Clinically spinal cord impingement has shown 10-15% in younger individuals, 20-25% of older. In the lumbar spine, 22% of asymptomatic patients under the age of 60 and 57% of over 60 had a significant abnormality of MRI scans.

DISC degeneration (so-called "dark disc disease"), was found near 98% in subjects over the age of 60. The crucial part of such facts is proof that "normal aging" is not clinically valid (as seen on scan), being a normal irrevocable process, yet not any cause of patient's symptoms. Such facts confirm a complete falsehood of any surgery based upon untrue facts. Imaging study is the surgeon's best friend (false diagnosis) and patient worst enemy (life disability). General screening is dangerous (though financially sound!) and leads to a patient life disability. Costly and misleading studies are not proven... and yet in USA 850.000 useless operations are carried out by "ethically enthusiastic" (!) surgeons with the active help of "hardware" corporations to a turn-over of 28 billion USD (of so-called) industry.

The phrase "We will get an MRI scan to see if there is anything wrong with the spine" is a false journey into dark unknown. No wonder that surgeons and others so-called "spine-related self-acclaimed specialists" are clinically blind and operations are carried being clinically false.



Many spinal conditions can cause pain directly or indirectly. Orthopaedic Medicine specialistics are best to diagnose. Specialistic history and examination (no MRI scan, x-rays... they have 5% validity that is for fracture only) are crucial for identyfing the most serious pathology (eg..: fracture, malignancy, infection or cauda equina syndrome). Above conditions are fortunately rare, less than 0.5 % of total disorders, 99% being mechanical deformities, trauma and/or mixed).

Two criterias are applied :

  1. Yellow flags
  2. Red flags


1. Yellow flags assessment for chronic pain and life disabilities (all surgeries = FAILED BACK PAIN SYNDROMES = psychosocial personality disorders):


  • sickness behaviour (e.g.: prolonged rest);
  • belief that pain/activity are harmful;
  • lack of support / social withdrawal;
  • work dissatisfaction poroblems;
  • emotional mood personalities (negativity, passiveness, stress, depression, manipulative personality (cheating);
  • application for social benefits/claims compensation;
  • overprotective family;
  • time of work (6 weeks plus)
  • addictions (alcoholism, smoking, drug abuse...);
  • irrational behaviour of treatment expectations ("surgery miracles", lay "expert self-believe = knowing it all -lay zero education, no or "little" knowledge is very dangerous, self-diagnosis, useless tests- ).

2. Red flags (serious conditions):


  • LBP (low back pain) can be caused by variety of pathologies (adjacent structure) being : thoracic/hip spine, visceral (pelvis/abdomen, kidney, ovaries, bladder );
  • CES (cauda equina syndrome = nerve trauma/compression/damage ). Symptoms are: leg weakness, loss of bowel/sexual functions, sensitivity changes around rectum/genitala ( saddle anaesthesia);
  • inflammatory conditions (rare): ankylosing spondylitis, polymyalgia rheumatica, rheumatoid arthritis (very rare cause of LBP), coccydinia;
  • infections: shingles before rash development, post-herptic neuralgia, discitis, osteomyelitis, bacterial/tuberculous, epidural abcess (post-surgical), neoplasm (secondary bone deposits);

Red flags are serious pathology indicators, never certainty (chronic back pain indicates suspicion of such conditions). Further investigations/referral should be considered in case of several red flags. Clinical experience judgement is crucial (e.g.: cancer/non-immediate referral, ces -immediate). Serious underlying pathology is not common. Specific questions are required to clarify (e.g. perineal numbness ). CES (medical history essential): saddle anaesthesia, recent bladder disfunction, faecal incontinence.
Physical examination: perianal sensory loss, laxity of the anal sphincter, severe/progressive deficit of lower extremities, major motor weakness/knee extension, ankle eversion, foot dorsiflexion. Spinal fractures: medical history: major trauma. fall, strenuous lifting, osteoporosis, sudden onset of central pain in the spine, which is relieved by laying down.
Physical examination: structural spinal deformity. Cancer or infection: medical history: age plus 50 or under 20. History of cancer: constitutional symptoms (fever, chills, unexpected weight loss), bacterial infection (e.g.: recent urinary tract). Drug abuse (intravenous), immune suppression, pain remaining supine, night pain = sleep disturbance/thoracic pain (aortic aneurysm ?). Myeloma /or rare primary cancer. Metabolic bone disease: osteoporosis (= vertebral collapse), osteomalacia, Paget disease. Asymptomatic (degenerative + structural changes): Spondylosis (spinal osteoarthritis + osteophythosis (bony spurs) + degenerative facet and discs ( DDD) ), spondylolisthesis/retro listhesis (forward /backward displaced with/without stress fracture in the pars interarticularis), severe scoliosis/kyphosis (idiopathic?).

EXAMINATION = DIAGNOSIS is the most important to establish CAUSE. ONLY Specialists in Orthopedic Medicine/Manipulative Therapy can DIAGNOSE.

Any medical so-called... diagnosis is FALSE,  just guessing the condition by name... NON = CLINICALLY / is false, especially those based upon useless.....Mri scans / 75% false /x-ray is valid ONLY 5%. ALL surgical pseudo-diagnosis is FALSE, as surgeons have NO skills to diagnose just operate. ALL operations are PHONEY../ SCAM..../ UK / USA and others /. Osteopaths and Chiropractors cannot diagnose and treat chronic conditions, the treatment is based upon WRONG principals, hence MISDIAGNOSIS. Wrong diagnosis leads to non-effective, useless treatment and a vicious circle follows useless therapies and medications. Hospitals / NHS are unhelpful in diagnosis, as they have no spinal specialists. The USA is the worst in the world, that's why they operate on 1.5 million patients/insurance SCAM / plus, every year and prescribe TOXIC  (read about Sacker leading killer / killing drugs.) 75000 people / USA / and 5000 people / UK, had been killed in the last year and how many more to come? Patients who are naive and desperate fall into a medical trap and ONLY when surgery fails they complain...this is too late. Those so-called surgeons who advocate useless surgery should undergo it THEMSELVES and experience doubtful..., but the ineffective outcome. Cheap is expensive, yet CRIPPLING LIFE MISERY often leads to suicide. Bertagnoli / Berlin carried out 6ooo disc replacement on desperate, NAIVE patients, with UNPROVEN results. LONG term. Those patients are experimental guinea pigs and WILL suffer chronic complications in the future. Bertagnoli has NO idea how to carry out a clinical DIAGNOSIS using scam MRI but protects himself with legal disclaimers indemnity, NOT be sued for damages. That is typical in case a fraud is proven, in any case, the poor patients have no legal chance.