Are Chiropractic X-rays Necessary?

Our St George chiropractic office utilizes digital x-ray. Most patients are pleased that the service is available. But, about once a month, cost-conscientious patient will ask if it is necessary. I appreciate the question. As healthcare consumers, we should demand the most efficient care possible and try to stream-line whenever possible.  When we consider the various costs associate with delivering healthcare, there are some areas where some fat can be trimmed.

X-rays are not fat.  They are an important part of the clinical picture.  Before any healthcare provider performs any intervention, they must first have a diagnosis, or understanding of the condition.  That understanding does not need to be, and rarely is it perfect in nature.  Rather, it needs to be the “reasonable best.”  We should have the best information available to us which is reasonable to obtain.  Take for example an MRI.  They are very good at detecting abnormalities of soft tissues.  An MRI costs about $1500.  Imagine what would happen to America’s healthcare system if every doctor ordered an MRI for every condition, every time.  We would go bankrupt in no time.  The backlogs would be horrible.  Instead of this scenario, doctors and chiropractors only order MRI when we find it reasonable, prudent, and appropriate for the patient care.  Often we order MRI only after the patient has had a therapeutic treatment trial and they failed to respond.  We have all heard the doctor say something like “try this treatment for 2 weeks.  If the problem doesn’t go away, then we can order an MRI.”  That is reasonable.  The cost-benefit ratio for the MRI suggests that one ought to wait-and-see.

X-rays cost about $125.  At only a fraction of the cost, they provide a lot of information.  With x-rays, we get a lot of bang-for-the-buck.  The diagnostic return on investment is very favorable.  The relatively low-cost makes it much more reasonable.

A proper x-ray taken at a chiropractic office or medical clinic can reveal some surprises from time to time.  Those surprises can influence the treatment plan for a condition.  Two examples from my office are below.

Note the slippage of the bottom vertebra. It is sliding forward over the top of the sacrum. This causes pain as the bottom of the spinal cord (cauda equina) has to make sharp turns to get around the offset in order to continue into the sacrum.

The first example is a gentleman who had been seeing a chiropractor in a different town.  He had been receiving regular chiropractic check-ups but his pain remained.  When his x-rays showed a spondylolisthesis at L5, it fully explained his pain pattern and why the other chiropractor was not able to help his pain.  They were using the wrong approach.  Using the information on the x-ray, we were able to tailor a specific treatment plan for his exact condition.

A second example is a woman who injured herself while doing side-bending yoga exercises.  We all know that yoga is supposed to help our backs become stronger and reduce pain.  So why did yoga hurt this person?  After examining her, I opined that x-rays would be a good idea.  I suspected a vertebral anomaly and that is exactly what we found on the film.  The film set below demonstrates her vertebral anomaly.  A vertebral anomaly is when a bone in the spine has an abnormal shape or extra parts.  In this case, the right side of L5 (the last bone in the spine) had an usual configuration on it’s right side.  The configuration was so odd that it actually interfered with normal movement.  When she did her side bending maneuver, it stressed the malformed pieces and an injury resulted.

Using this valuable information, the patient was able to modify her work-out routine to avoid stressing that region.  We were also able to formulate a specific treatment plan to get her strong and pain-free.

When you come to our office and ask if x-rays are necessary, know that I will only take them if it is reasonable and prudent. If I do take the x-rays, understand that it is in your best interest for your health and well-being. One very nice feature about our digital x-ray system is that you are able to take a copy of your x-rays home with you on a CD. You can store them for your personal medical record or take them to another doctor for a 2nd opinion.

Dr. Andrew White
St George UT Chiropractic Physician

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