Presentation and Initial Workup
A 36-year-old female presented on Nov. 18, 2025, with lumbar pain and left lower extremity radiculopathy. Following a comprehensive history, physical examination, and radiographic evaluation to assess anatomical and biomechanical factors, an immediate lumbar MRI was ordered due to the patient’s radiculopathic symptoms and clinical findings.
Chiropractic Review and Medical Collaboration
Upon reviewing the MRI images later that day, the treating chiropractor identified “massive” abnormal findings within the central canal spanning the entire canal from L2 to L4. Recognizing the clinical significance of this finding, he contacted one of his graduate MRI instructors for immediate consultation, who then collaborated with a medical neuroradiologist affiliated with a New York medical school for confirmation.
Based on the available MRI sequences (including non-contrast T1 and T2 axial and sagittal views), the consulting clinicians concluded there was a probable extensive intradural mass lesion, with a differential diagnosis that included ependymoma, extending from approximately the L2 level into the inferior spinal canal region of L4.
Given the potentially serious implications, the chiropractor made the clinical decision to initiate an urgent referral for a specialist evaluation to secure immediate additional imaging (including contrast studies).
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If a chiropractor misses a critical diagnosis causing a life-threatening situation, and a medical doctor catches it, the story becomes an indictment of the entire profession – splashed on billboards, featured in The New York Times, and spread across social media like wildfire. But when the reverse happens – when a medical doctor misses a critical diagnosis and a DC identifies the pathology – there's rarely a whisper.
Over my 44 years in practice, I've repeatedly encountered this double standard, including in recent remarks to me by medical specialists directed at our profession.
Yet the reality is that through contemporary chiropractic doctoral training and advanced postgraduate education, many DCs have developed diagnostic expertise that meets – and in many cases exceeds – that of their medical counterparts. Increasingly, this is now playing out on a global scale as more DCs commit to clinical excellence. The result has been a meaningful rise in collaborative care, with one undeniable beneficiary: the patient.
Today, academic joint partnerships, such as those between Cleveland University Kansas City, Chiropractic and Health Sciences and the State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Office of Continuing Medical Education, are expanding access to advanced, credentialed graduate education for DCs. These are opportunities once largely limited to MDs. Chiropractors globally are taking full advantage, and while this training often increases utilization within clinical practices, the true impact is measured in improved outcomes and better-informed patient care.
— Dr. Mark Studin
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Referral Coordination
To ensure timely management, the chiropractor reviewed regional referral resources and initiated an urgent referral to Duke University Neurosurgery, widely recognized for advanced spine and neurosurgical care. He personally contacted the facility to communicate the urgency and expedite the consultation process.
The following morning, the chiropractor met with the patient and reviewed the MRI findings. He explained that, beyond degenerative changes and disc pathology, there were additional concerning findings requiring immediate clarification and specialty assessment, with intervention as clinically warranted.
He emphasized that the suspected lesion could represent a serious diagnosis and warranted urgent follow-up. The patient was advised that further treatment decisions in the chiropractic office would be deferred until a conclusive diagnosis was established. The patient expressed understanding and was encouraged to stay in contact with the chiropractor.
Radiology Report Omission and Follow-Up Communication
Later that same afternoon, the formal radiology report was received. Notably, the report did not describe the suspected intradural lesion, and made no mention of the central canal abnormality identified by the chiropractic and neuroradiology reviewers.
The chiropractor contacted the imaging facility to discuss the discrepancy with the interpreting radiologist, who was identified as a general radiologist (lacking in neuroradiology specialty training). After repeated attempts and two days of delayed responses, the chiropractor eventually reached the radiologist directly and described the findings and clinical concern. He also informed the radiologist of his advanced postgraduate training in spinal MRI interpretation, including tumor assessment protocols through medical and chiropractic academic fellowship programs.
The radiologist stated that his observed finding was believed to represent an artifact (a typical comment when potential missed pathology is realized within radiology), potentially related to motion, and therefore was not included in the report. After the chiropractor “focused him on the lesion,” he recommended repeat imaging on a higher-strength magnet (1.5T or 3T) with and without contrast to “rule out his conclusion of an artifact.”
The chiropractor requested an addendum noting the concern for a possible intradural mass to support appropriate follow-up and reduce barriers associated with further insurance authorization. The radiologist “begrudgingly” agreed to provide an appended report and was not polite in the process.
The chiropractor’s comment after the encounter was, “I just saved him from a potential malpractice case, yet he was disrespectful and unprofessional. Perhaps it was because I was a chiropractor and his prejudice was deeper than his desire to get it right.”
Clinical Implications
From the perspective of the consulting clinicians, the lesion demonstrated characteristics consistent with a true intradural pathology, including persistence across multiple levels and imaging views easily ruling out artifact. Critically, the finding was recognized rapidly by clinicians with specialized training in neuroradiology (including the chiropractor), while the initial radiology report omitted it, erroneously blaming an artifact, and irresponsibly omitted even that finding.
This case reinforces a central point: Specialized training and disciplined interpretive protocols matter, regardless of professional designation. When high-risk pathology is recognized early, outcomes can be substantially improved. Conversely, missed or delayed identification of spinal tumors may significantly worsen prognosis depending on tumor type, location and time to definitive care. This is one tumor type that if missed over time, typically has dire outcomes.
The Double-Standard Problem: Visibility, Narrative and Accountability
If this clinical sequence had occurred in reverse – if a DC had failed to detect suspicious imaging findings later identified by a medical specialist – the event would likely be framed as evidence of systemic inadequacy in chiropractic training and clinical judgment.
Such an imbalance is not merely unfair; it is counterproductive. Patient safety is best served when healthcare disciplines apply consistent standards to diagnostic performance, communication, accountability, and professional recognition. Errors should be approached with the same seriousness regardless of provider type, and diagnostic excellence should be acknowledged wherever it occurs.
The Takeaway
This case exemplifies how advanced training in chiropractic spine care can contribute meaningfully to early identification of potentially serious pathology. It also underscores the need to confront longstanding professional double standards that shape how diagnostic errors and successes are framed in the public and professional spheres.
If healthcare is to remain patient-centered, the discussion must shift from discipline-based narratives to a consistent expectation: Clinical excellence is required of all providers, and high-level diagnostic contribution should be recognized regardless of professional title.
