Are X-rays necessary prior to MRI after CT-scan has indicated multilevel degenerative cervical disease?

Recently while in the hospital for atrial fibrillation, I told my cardiologist that I am having intermittent tingling and numbness in my left arm. He ordered a CT-scan to evaluate for cervical disc disease or herniated disc.

The three-page report impression stated "multilevel degenerative disease throughout the cervical spine, as detailed above..." and ended with "Correlation with MRI may be useful to further characterize central canal stenosis and disc disease."   Examples of the details are mild to moderate central canal narrowing, mild anterolisthesis, moderate left neuroforaminal narrowing, disc osteophyte complex, uncovertebral osteophytosis and facet arthropathy.  

As suggested by my cardiologist, I gave a copy of the report to my new primary care physician (PCP) when I met with him for the very first time. I told him I also have sharp pain in my left hip now and then. He gave me an order for x-rays on my spine and hip, saying the purpose of the x-rays is "to confirm the narrowing is there."  I found this surprising because I thought the CT-scan had established different types of narrowing, but I did not question it.

When I saw my PCP a week later I told him about my reluctance to have the x-rays unless they are necessary. He said he thinks Medicare won't pay for the MRI unless I have X-rays first.

Question 1. Does anyone know whether Medicare requires X-rays before paying for an MRI if a patient already has had a CT-scan that shows "multilevel degenerative disease throughout the cervical spine?"  

Question 2. I would appreciate opinions on whether from a medical standpoint, at this point in the diagnostic process, X-rays are needed, desirable, or standard practice before I get an MRI.

BTW, I'm all for necessary x-rays; I'm very thankful for radiology technology. I like my new PCP and regret that I'm having difficulty asking the right questions when talking with him. Any help will be greatly appreciated.

[selmaS]

  Hi...just a thought, but most ins companies will want  x rays done first...plus x rays show bone abnormalities and MRI's are for soft tissues......

Most times the Drs hands are tied as to what they can do and when....

  It can also be a problem as ur  dr is a PCP and it may be harder for him to get a more detailed testing, where a specialist may not.....

  I had Xrays and MRI's and CT scans all for the same thing...so, I guess it all depends on the dr and ins u have.

  Wish I could say for sure.

   Why r u reluctant, did u recently have an x ray?

    "selma"

[jann249]

Thanks so much for your response.  I'm reluctant because I just had (on Oct 29) a CT-scan that shows I have degenerative disk disease.

I think of a CT-scan as being an advanced x-ray. I think of x-rays as providing less information than CT-scans, not more. If CT-scans are advanced x-rays, then they should give a better picture of bone abnormalities than x-rays - right?  So it seems it's a step backward to have x-rays after the CT-scan.

Even so, I can imagine that, after a CT-scan and a MRI to do the primary diagnosis of DDD, x-rays might be needed to better define conditions in very specific areas.  As I understand it, X-rays use a LOT less radiation than CT-scans, so if the doctor wanted a better look at a specific area after the CT-scan and MRI have been completed, then an x-ray might be the best thing. Wish I knew someone who could tell me if this is right.

I have Medicare and supplemental insurance. I called Medicare and was told that x-rays are not required prior to an MRI; all that is required is for a doctor to order an MRI because it is medically necessary.  So apparently it's not an insurance problem. My supplemental will help if Medicare pays first.

I think ordering an x-ray to determine whether an MRI is justified to fully diagnose DDD may be standard practice among doctors. But what if the patient already has had an CT-scan (an advanced x-ray) that shows DDD? If the x-ray doesn't contribute new information at this point in the diagnosis, then it's a waste of Medicare dollars and exposes me to unnecessary radiation, even if it is a small dose compared to CT-scans.

selmaS, hope this answers your questions. Again, thanks so much for replying - yours is the only reply I've gotten so far even though I posted here and on the Radiology forum.

[selmaS]

  I totally agree with u on wondering y Drs would take a step back, and ins would be a reason as would the Dr being a PCP verus a specialist...

I could be way off base, but could be part of the reason.

May I ask, what symptoms u r having?..DDD is not uncommon as we all will develop it as we age...in fact it is not really a disease, just a name of aging spinal cord...now unless u have bulging disks or stinosis I am not sure y there would be a need for more testing??

  U may want to see a orthopedist.....

I also have DDD and a few bulging disks with stinosis, and as of now am not doing nething for it as I had other more pressing medical issues.

  Not realizing this was recent (the CT scan) I know it's there...I missed it...lol...I wondered , but totally agree the CT is high radiation and u do not need to be exposed to more....
I would tell ur PCP u want a MRI and ask him to try to get approval, if not appeal it.

     I hope u find a way to communicate with ur PCP

              "selma"

[jann249]

My only noticeable symptom was that I had intermittent tingling and numbness that went from my left shoulder down the inside of my arm to my little finger and a sharp pain in my left hip now and then.

Since I had the CT-scan the arm symptoms have almost disappeared (but not the ones in my hip). I think I may have slept on my shoulder wrong and it caused the arm symptoms, even so, the CT-scan confirms that I have DDD.

The CT-scan indicates I have central canal stenosis and disc disease. Not sure whether I have bulging disk.  The CT-scan details said I have mild to moderate central canal narrowing, mild anterolisthesis, moderate left neuroforaminal narrowing, disc osteophyte complex, uncovertebral osteophytosis and facet arthropathy.

I'm especially concerned about having central canal stenosis, but don't know whether anything can be done to stop it from getting worse or to reverse it. Think I'll ask about that on this forum. Also, will ask which type of specialist I should see.

Thanks again for answering. You are helping me think through what my next steps should be.

[jann249]

Decided to search this forum for spinal stenosis before asking about it. Lots of interesting and informative posts, so I'm going to be reading and taking notes for a while. So far I've read that spinal stenosis is progressive and the only help is surgery - had hoped for more promising info.

[selmaS]

  I am wondering here, but get shoulder and hip pain  after a nights sleep, the reason I get it is I have EDS and my joints pop in and out of joint....this also can cause early issues with DDD.

  U way want to see a rheumatoid Dr...just a thought.

  I have cervical spinal stinosis and I was dx'd with it when I was 27...I am not 52....nothing was done and nothing is planned at this time.

  We do have a EDS group here on MedHelp with video's done by a Dr with EDS that explains what it is if u r not familiar.

    "selma"

[jann249]

Never heard of EDS before; I'll read about it.

I really appreciate your statement: "I have cervical spinal stinosis and I was dx'd with it when I was 27...I am not 52....nothing was done and nothing is planned at this time." I've wondered how fast-growing cervical stinosis can be and how long it could go without anything being done. That's very encouraging to me.

[selmaS]

  Sorry that was to be I was Dx'd at 27 and am now 52 (not  NOT).......


The EDS videos in the EDS group here on MedHelp are by a Dr that also has EDS...so I find them informative....and it may help u understand it m,ore then I could by typing my typos...lol...

  "selma"

[jann249]

DrBrandonNevel answered this question for me on the medhelp.org Radiology Expert Forum. Just thought I'd post this in case someone else is searching for info about the use of x-rays and MRIs in the diagnosis of degenerative disease.

http://www.medhelp.org/posts/Radiology/Are-X-rays-necessary-prior-to-MRI-after-CT-scan-has-indicated-multilevel-degenerative-cervical-disease-/show/1617764

Thanks to Dr Nevel and to all medical experts who answer our questions and thanks to the founder of this site.