MRI’s were once considered the gold-standard for identifying the cause of low back pain. Accumulating reveals that MRIs cannot identify the cause of low back pain and sciatica, and surgeries based on MRIs cause poor long-term outcomes.

Yet still, unknowing patients request them, radiologists read them, and spine surgeons plan surgeries based on them.

Why do Doctors order MRIs?

History teaches us it’s difficult for some doctors to accept new treatment paradigms. They’re especially hesitant to embrace change not taught by their alma maters. Bloodletting was the mainstay medical treatment taught at all schools, and likewise, many academic institutions still wrongly teach doctors to order MRIs to diagnose low back pain. Even every radiology society condemns using routine MRIs to diagnose low back pain.

Talk to friends who’ve had spine surgery based on MRI, and you’ll likely recognize a recent study in a prestigious journal revealed that 98% of Spine Surgeons said they’d never undergo spine surgery when asked if they’d undergo Spine Surgery. That’s like Michelin Three-Star Chefs saying they’d never eat their own food.

Even Tiger Woods fell victim because top spine surgeons relied on MRIs to plan his spine surgeries. He underwent five spine surgeries, numerous injections, and now needs a sixth spine surgery. The lumbar MRI didn’t serve him well. In Tennessee, only one out-of-four spine fusion patients returns to work after fusion surgery, and like Tiger, their MRIs aren’t serving them well.

One study published in the prestigious New England Journal of Medicine confirmed that over 65% of adults with no pain have bulged and herniated discs. Therefore, seeing “slipped,” bulged, or herniated discs on MRI doesn’t mean anything. It’s like seeing blue eyes or green eyes or brown eyes. This motivated me to develop the Annulogram test.

Anatomy Lesson explaining why Annulograms

Discs are the five cushions between the lumbar vertebrae bones, and they cause most low back pain. They’re much more than simple cushions between bones, because they’re somewhat like living organs. They’re hockey-puck shaped, with a center jelly core called Nucleus Pulposus and 17 outer rings called Annulus Fibrosus, meant to hold jelly inwards. Because disc rings resemble Annular rings of a tree, they’re collectively called Annulus Fibrosus.

Here’s the key fact: Nucleus Pulposus gel belongs in the disc’s center, and if annular tears allow gel to leak outwards, the human body perceives of that leaked gel as a foreign substance, like battery acid, and attacks that gel. This is known as the “Foreign Body Response” and is characterized by inflammation.

If gel flows within the Annulus Fibrosus’ layers, like a rat in a maze, it causes inflammation within the Annulus, causing spasm and low back pain. If the gel leaks out of the disc and onto adjacent spinal nerves passing each disc, it inflames that portion of the spinal nerve, causing sciatica, referred to as radiculopathy. (Latin for “Root Pathology”)

This “foreign body response” caused by gel isn’t unique to discs because it occurs in seven other parts of the human body. For example, the eye’s clear Vitreous Humor gel also causes severe inflammation within the skull and face when it leaks from a torn eyeball. Because low back pain is caused by inflammation resultant from chemicals leaking from discs, the Annulogram is an optimal test because it precisely identifies all disc Annular tears.

What is an Annulogram?

The Annulogram is a pain-free test that takes about 10-15 minutes. Using x-ray guidance, very small needles are directed into the bottom 4 lumbar discs, and a small amount of x-ray contrast is injected into each disc’s Annulus Fibrosus to identify tears and leaks. Unlike lumbar MRIs and other imaging tests, it doesn’t require high-cost imaging equipment, and leaves no doubt.

The value of the Annulogram is that it identifies every tear in the region of symptoms. Any tear is a leak or potentially a leak, and so all tears are treated. Optimal treatment, to date, is to seal with natural Fibrin. In those with chronic low back pain, the average number of discs with tears is approximately 3.5 discs/person. Not all tears cause symptoms, but all symptoms are caused by tears, and therefore logic dictates to simply treat all tears identified by Annulogram. Disc tears are treated using Fibrin sealant. It’s an FDA-Approved Biologic with the ability to heal and grow disc tissue. Neither Stem Cells nor anything else has demonstrated ability to regrow disc tissue and heal discs.

Why Annulogram Instead of MRI?

The cause of low back pain is chemical, specifically chemical reactions caused by disc gel that leaks out of disc tears. Thousands of scientific publications confirm this fact that it’s not pinched nerves, nor bulged, herniated, nor “slipped discs” seen in MRI. Most people without any pain have bulged discs and pinched nerves, and so they’re called “incidental findings” and not the cause of symptoms. Unknowing physicians still mistakenly operate on these “incidental findings.”

The MRI cannot see tears, so physicians occasionally blame low back pain on depression or other psychological issues and treat patients with anti-depressants and therapy. Mayo Clinic and Harvard even have “Pain Management Programs” headed by psychologists attempting to correct “psychological issues” when the problem was an Annular disc tear not seen by MRI.  We performed Annulograms on those “depressed” patients, identifying and treating Annular tears, and providing relief from pain and so called “depression.”

To understand a primary reason MRIs can’t identify the cause of low back pain, one must understand the underlying cause of most low back pain. Low back pain is caused by inflammation, not pinched nerves. Pinched nerves causing pain alone was a misconception. During the past decades, doctors were taught that low back pain was caused by disc bulges, herniations, and pinched nerves, and this was wrong and still confuses some “old-school” physicians. Pinched nerves don’t cause low back pain, but instead, it’s chemical inflammation caused by small tears, called Annular tears, and lumbar MRIs cannot identify those tears.  Identifying the pain source isn’t as simple as identifying bulged discs or pinched nerves.

A Personal Experience  

I met a wonderful patient; Wikipedia calls him “the Pioneer of Modern Cardiology” because he introduced coronary arteriograms and angioplasty to replace open heart surgery. He was met with resistance by the surgical establishment for introducing his non-surgical diagnosis and treatment, “coronary arteriograms and angioplasty” for heart disease. Before meeting me, he underwent two spine surgeries based on MRI and got no relief. He was scheduled for his third spine surgery until he heard about Annulograms and canceled that surgery to travel to me to undergo an Annulogram. The test identified disc tears unseen by MRI, which I treated using Fibrin, finally providing him relief. He proclaimed: “Your Annulogram is to the Spine, what my Coronary Arteriogram is to the heart.”

I enjoy days Spine Surgeons visit to learn about Annulograms, because they all say almost exactly the same thing the first time they observe an Annulogram. They say, “Wow, I didn’t know what I didn’t know!”

Kevin Pauza, M.D. is the Chief Medical Advisor and Director of Discseel® Technologies. After helping thousands of patients who failed to experience relief after spine surgery, it became evident to Dr. Pauza that current methods needed to change. He is the first physician in history to pursue FDA approval for using biologics to treat the spine and is a physician to HRM and the Royal Family.