Dear TAC: I would like to comment on an article by Glenn Becker published in the Volume 23. Issue 2 edition of your magazine. In his article, he states. "Spinal Ultrasound...provides useful information in identifying signs of inflammation in the facets, nerve roots, tendons, ligaments, and muscles." Your readers should understand that this statement is only partially true. The musculoskeletal applications of diagnostic ultrasound for the superficial soft tissues, such as the rotator cuff muscles, the Achilles" tendon, the carpal tunnel,! as well as atrophy of the spinal musculature has been scientifically validated. However, evaluation of facet joint and nerve root inflammation in an adult (outside the operating room) has never been reported in the peer reviewed scientific literature. In 1995. the American College of Chiropractic Radiology adopted the following position statement: Diagnostic ultrasound has been shown to he a useful modality for evaluating certain nuisculoskeletal complaints. Fetal, pediatric. and intra-operative applications have been published in the scientific literature. The quality of ultrasound is extremely dependent on operator skill. The resolution abilities of the equipment max have an impact on diagnostic yield and accuracy. Consequently, the importance of training to establish technologic as well as interpretive competency cannot be overstated. The application of diagnostic ultrasound in the adult spine in areas such as disc hemiation. spinal stenosis and nerve root pathology is inadequately studied and its routine application for these purposes cannot be supported by the evidence at this time. The American College of Radiology (ACR). in 1995, issued the following statement: The use of diagnostic spinal ultrasound in the evalua- lion of pain or radiculopathy syn dromes {facet joints and capsules, nerve and fascia! edema, and other subtle paraspinous abnormalities) \ currently has no proven clinical utility as a screening, diagnostic or \ adjunctive imaging tool. I Furthermore, a 1996 bulletin pub- i lished by the ACR's Commission on I Ultrasound recommended: j Some key audiences—tlie med- i ical press, major automobile and \ health insurers and other third ! party payers—need to he better ] informed about the unsubstanti- \ ated claims bv some medical pro- j fessionals and equipment nianu- ! faclurers that ultrasound is effec- j live in diagnosing spinal and \ paraspinal injuries. j Since those position statements have I been published, there have been scien- | tific studies documenting the value of I real time ultrasound assessment of the j segmental stabilizing muscles of the [ spinal segments. However, the num- | bers and general applicability of these j studies remains insufficient to draw [ broad-based conclusions that would guide clinical care pathways. No evidence to substantiate the belief by some that nerve root and facet inflammation can be accurately assessed with ultrasound has been published in the peer reviewed scientific literature. Becker does not clarify these important points to readers, thus leaving the potential for misinterpretation of the state of the evidence. MichaelS. Barn: D.C.. DACBR President, The American Chiropractic College of Radioing v
