Skip to main content

10.08.2019 | Original Article

“Less is better”—always true?

verfasst von: Franca Dicuonzo, Stefano Purciariello, Stefano Andresciani, Aurora De Marco, Antonio Colamaria, Antonio Calace

Erschienen in: Neurological Sciences

Einloggen, um Zugang zu erhalten

Abstract

Objective

The aim of the study is to try to explain what an overtreatment is and which ones are the possible risks related to an excess of simplification in the medical practice, through the description of an emblematic clinical case.

Methods

In the present article, we report the case of a female patient aged 57 who complained about lower back pain and crural neuralgia and had a lumbar and sacral magnetic resonance imaging performed in the Department of Neuroradiology in Bari showing suspicious repetitive bone lesions; therefore, the patient underwent several medical procedures and laboratory exams which ended with a surgical removal of a left L3–L4 foraminal disc herniation and a bone biopsy.

Results

When it was finally possible to exclude any other diseases including thyroid neoplasms, a “reassuring” osteoporosis diagnosis has been made since the lesions were likely to be degenerative and the patient underwent menopause 7 years ago. However, the multiplicity of the lesions of the vertebrae and of the pelvic bones as well as their signal could not be ignored, so that a close magnetic resonance imaging follow-up has been recommended.

Conclusions

The present case is therefore a good example of overtreatment which may lead to delicate questions, investigating any possible mistakes in the diagnosis procedure as well as the role that defensive medicine is playing nowadays on medical procedures and the economic impact that all this can have on our healthcare system. In the end, we may ask ourselves: is “less” better or is “more” always “more?”
Literatur
1.
Zurück zum Zitat Rosenbaum L (2017) The less is more crusade - are we overmedicalizing or oversimplifying? N Engl J Med 377(24):2392–2397CrossRef Rosenbaum L (2017) The less is more crusade - are we overmedicalizing or oversimplifying? N Engl J Med 377(24):2392–2397CrossRef
2.
Zurück zum Zitat Ishiyama M, Fuwa S, Numaguchi Y, Kobayashi N, Saida Y (2010) Pedicle involvement on MR imaging is common in osteoporotic compression fractures. AJNR Am J Neuroradiol 31(4):668–673CrossRef Ishiyama M, Fuwa S, Numaguchi Y, Kobayashi N, Saida Y (2010) Pedicle involvement on MR imaging is common in osteoporotic compression fractures. AJNR Am J Neuroradiol 31(4):668–673CrossRef
3.
Zurück zum Zitat Takigawa T, Tanaka M, Sugimoto Y, Tetsunaga T, Nishida K, Ozaki T (2017) Discrimination between malignant and benign vertebral fractures using magnetic resonance imaging. Asian Spine J 11(3):478–483CrossRef Takigawa T, Tanaka M, Sugimoto Y, Tetsunaga T, Nishida K, Ozaki T (2017) Discrimination between malignant and benign vertebral fractures using magnetic resonance imaging. Asian Spine J 11(3):478–483CrossRef
4.
Zurück zum Zitat Sung JK, Jee W, Jung J et al (2014) Differentiation of acute osteoporotic and malignant compression fractures of the spine: use of additive qualitative and quantitative axial diffusion-weighted MR imaging to conventional MR imaging at 3.0 T1. Radiology 271(2) Sung JK, Jee W, Jung J et al (2014) Differentiation of acute osteoporotic and malignant compression fractures of the spine: use of additive qualitative and quantitative axial diffusion-weighted MR imaging to conventional MR imaging at 3.0 T1. Radiology 271(2)
5.
Zurück zum Zitat Zaia A, Eleonori R, Maponi P, Rossi R, Murri R (2006) MR imaging and osteoporosis: fractal lacunarity analysis of trabecular bone. IEEE Trans Inf Technol Biomed 10(3):484–489CrossRef Zaia A, Eleonori R, Maponi P, Rossi R, Murri R (2006) MR imaging and osteoporosis: fractal lacunarity analysis of trabecular bone. IEEE Trans Inf Technol Biomed 10(3):484–489CrossRef
6.
Zurück zum Zitat Eastell R, O’Neill TW, Hofbauer LC, Langdahl B, Reid IR, Gold DT, Cummings SR (2016) Postmenopausal osteoporosis. Nat Rev Dis Primers 2:16069CrossRef Eastell R, O’Neill TW, Hofbauer LC, Langdahl B, Reid IR, Gold DT, Cummings SR (2016) Postmenopausal osteoporosis. Nat Rev Dis Primers 2:16069CrossRef
7.
Zurück zum Zitat Castro-Mateos I, Pozo JM, Cootes TF, Wilkinson JM, Eastell R, Frangi AF (2014 Jun) Statistical shape and appearance models in osteoporosis. Curr Osteoporos Rep 12(2):163–173CrossRef Castro-Mateos I, Pozo JM, Cootes TF, Wilkinson JM, Eastell R, Frangi AF (2014 Jun) Statistical shape and appearance models in osteoporosis. Curr Osteoporos Rep 12(2):163–173CrossRef
8.
Zurück zum Zitat Eastell R, O’Neill TW, Hofbauer L et al (2016) Cummings postmenopausal osteoporosis, vol 2. Macmillan Publishers Limited, part of Springer Nature Eastell R, O’Neill TW, Hofbauer L et al (2016) Cummings postmenopausal osteoporosis, vol 2. Macmillan Publishers Limited, part of Springer Nature
9.
Zurück zum Zitat Orimo H, Hayashi Y, Fukunaga M, Sone T, Fujiwara S, Shiraki M, Kushida K, Miyamoto S, Soen S, Nishimura J, Oh-hashi Y, Hosoi T, Gorai I, Tanaka H, Igai T, Kishimoto H (2001) Diagnostic criteria for primary osteoporosis: year 2000 revision. J Bone Miner Metab 19:331–337CrossRef Orimo H, Hayashi Y, Fukunaga M, Sone T, Fujiwara S, Shiraki M, Kushida K, Miyamoto S, Soen S, Nishimura J, Oh-hashi Y, Hosoi T, Gorai I, Tanaka H, Igai T, Kishimoto H (2001) Diagnostic criteria for primary osteoporosis: year 2000 revision. J Bone Miner Metab 19:331–337CrossRef
10.
Zurück zum Zitat El Maghraoui A, Rezqi A, El Mrahi S et al (2014) Osteoporosis, vertebral fractures and metabolic syndrome in postmenopausal women. BMC Endocr Disord 14:93CrossRef El Maghraoui A, Rezqi A, El Mrahi S et al (2014) Osteoporosis, vertebral fractures and metabolic syndrome in postmenopausal women. BMC Endocr Disord 14:93CrossRef
11.
Zurück zum Zitat Takayanagi A, Hariri O, Ghanchi H et al (2017) Unusual metastasis of papillary thyroid cancer to the thoracic spine: a case report, new surgical management proposal, and review of the literature. Cureus. 9(4):1132 Takayanagi A, Hariri O, Ghanchi H et al (2017) Unusual metastasis of papillary thyroid cancer to the thoracic spine: a case report, new surgical management proposal, and review of the literature. Cureus. 9(4):1132
12.
Zurück zum Zitat Tsuchiya R, Fujimoto K, Inage K et al (2017) Radical surgery of only the anterior elements of the spine at the posterior element fusion level due to metastatic thyroid cancer. Case Rep Orthop 2017:2365808PubMedPubMedCentral Tsuchiya R, Fujimoto K, Inage K et al (2017) Radical surgery of only the anterior elements of the spine at the posterior element fusion level due to metastatic thyroid cancer. Case Rep Orthop 2017:2365808PubMedPubMedCentral
13.
Zurück zum Zitat Slutzky-Shraga I, Gorshtein A, Popovitzer A et al (2018) Clinical characteristics and disease outcome of patients with non-medullary thyroid cancer and brain metastases. Oncol Lett 15(1):672–676PubMed Slutzky-Shraga I, Gorshtein A, Popovitzer A et al (2018) Clinical characteristics and disease outcome of patients with non-medullary thyroid cancer and brain metastases. Oncol Lett 15(1):672–676PubMed
14.
Zurück zum Zitat Armao D, Semelka RC, Elias J (2012) Radiology’s ethical responsibility for healthcare reform: tempering the overutilization of medical imaging and trimming down a heavyweight. J Magn Reson Imaging 35:512–517CrossRef Armao D, Semelka RC, Elias J (2012) Radiology’s ethical responsibility for healthcare reform: tempering the overutilization of medical imaging and trimming down a heavyweight. J Magn Reson Imaging 35:512–517CrossRef
Metadaten
Titel
“Less is better”—always true?
verfasst von
Franca Dicuonzo
Stefano Purciariello
Stefano Andresciani
Aurora De Marco
Antonio Colamaria
Antonio Calace
Publikationsdatum
10.08.2019
Verlag
Springer International Publishing
Erschienen in
Neurological Sciences
Print ISSN: 1590-1874
Elektronische ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-019-04016-w

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Neu im Fachgebiet Neurologie

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.