Radiologist Missed Spinal Tumor Found by Chiropractor

Citation: Clare T., Studin M. (2026) Radiologist Missed Spinal Tumor Found by Chiropractor, Dynamic Chiropractor (44) 3, pgs 18, 27

INTRODUCTION

By: Mark Studin, DC, FPSC, FASBE(C)

If a chiropractor misses a critical diagnosis 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 diagnosis and a chiropractor 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 directed at our profession.

Yet the reality is that through doctoral training and advanced postgraduate education, many doctors of chiropractic (DCs) have developed diagnostic expertise that meets—and in many cases exceeds—that of their medical counterparts. Increasingly, this is 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.

To highlight why advanced training is no longer optional for chiropractors, consider this case involving Dr. Tim Clare, a senior Fellow candidate in Primary Spine Care in Charlotte, North Carolina. A radiologist substantially misread his patient’s lumbar MRI—missing what appears to be a primary spinal canal tumor.

Case Summary: Suspected Intradural Mass Missed in Initial Radiology Report

By: Timothy Clare, DC, FPSC(C)

       Mark Studin, DC, FPSC, FASBE(C)

Presentation and Initial Workup

A 36-year-old female presented on November 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 urgent lumbar MRI was ordered due to the patient’s radiculopathic symptoms and clinical findings.

The MRI was ordered promptly. At the subsequent visit, the patient provided the MRI disc; however, a formal radiology report had not yet been received.

Chiropractic Review and Medical Collaboration

Upon reviewing the MRI later that day, the treating chiropractor, Dr. Tim Clare identified abnormal findings within the central canal spanning the approximate region of L2 to L4. Recognizing the clinical significance of this finding, Dr. Clare contacted Dr. Mark Studin, one of his graduate instructors, for immediate consultation. Dr. Studin, in turn, collaborated with a medical neuroradiologist affiliated with a New York medical school for confirmation.

Based on the available MRI sequences (including T1 and T2 axial and sagittal views), the consulting clinicians concluded there was a probable 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, Dr. Clare made the clinical decision to initiate urgent referral for further imaging (including contrast studies) and specialist evaluation.

Referral Coordination

To ensure timely management, Dr. Clare 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, Dr. Clare 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. 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 an accurate diagnosis was established. She expressed understanding and was encouraged to stay in contact with Dr. Clare.

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 noted by the chiropractic and neuroradiology reviewers.

Dr. Clare contacted the imaging facility to discuss the discrepancy with the interpreting radiologist, who was identified as a general radiologist. After repeated attempts and two days of delayed responses, Dr. Clare 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 programs.

The radiologist stated that the observed finding was believed to represent an artifact (a typical comment when potential missed pathology is found with radiology), potentially related to motion, and therefore was not included in the report. He recommended repeat imaging on a higher-strength magnet (1.5T or 3T) with and without contrast if clinical concern persisted. Dr. Clare requested an addendum noting the concern for a possible intradural mass to support appropriate follow-up and reduce barriers associated with insurance authorization. The radiologist “begrudgingly” agreed to provide an appended report and was not polite in the process.

Clinical Implications

From the perspective of the consulting clinicians, the lesion demonstrated characteristics more consistent with a true intradural pathology than with artifact, including persistence across multiple levels and imaging views. Critically, the finding was recognized rapidly by clinicians with specialized training, while the initial radiology report omitted it, erroneously blaming an artifact, but 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; if missed, it 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 radiologist—the event would likely be framed as evidence of systemic inadequacy in chiropractic training or clinical judgment. In contrast, when chiropractors identify missed pathology, the case is rarely elevated as evidence of clinical value, diagnostic expertise, or the need for collaborative respect.

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.

Conclusion

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.

FOLLOW-UP 3 months post accurate diagnosis by Dr. Clare. The patient had spinal surgery at Duke Medical for excision of the Epnedymoma (Tumor), and now has a minimal 5--year survivale rate upwards of 88%.