Diagnostic testing methods
Evaluation of back and neck pain requires a physician
experienced in diagnosing spinal conditions. The work-up begins
with a detailed history and physical examination. Your medical
history helps the doctor understand your back and neck pain and
the influence of your lifestyle on your pain.
During your physical exam, your physician will try
to pinpoint the source of pain. Simple tests for flexibility and
muscle strength may also be conducted. Diagnostic tests may be ordered
to confirm the location and source of your pain.
Diagnostics may include:
X-rays are usually
the first step in diagnostic testing methods. X-rays show bones
and the spaces between the bones.
MRI (magnetic resonance imaging)
uses a magnetic field and radio waves to generate highly-detailed
pictures of the inside of your body. Because X-rays only show bones,
MRIs are needed to see soft tissues like discs in the spine. These
images help your doctor provide a more accurate diagnosis. This type
of imaging is very safe and usually pain free.
CT scan/myelogram - A CT scan is
similar to an MRI in that it provides more diagnostic information
about the internal structures of the spine. A myelogram is used to
diagnose a bulging disc, tumor or changes in the bones surrounding
the spinal cord or nerves. A local anesthetic is injected into your
low back to numb the area. A lumbar puncture (spinal tap) is then
performed. A dye is injected into the spinal canal to reveal where
Bone Scan - Bone imaging is used
to detect infection, malignancy, fractures and arthritis in any part
of the skeleton. Bone scans are also used for finding lesions for
biopsy or excision.
Discography - Discography is used
to determine the internal structure of your disc. It is performed
by using a local anesthetic and injecting a dye into your disc under
X-ray guidance. An X-ray and CT scan are performed to view the appearance
of the disc composition to determine if its structure is normal or
abnormal. In addition to your disc appearance, your doctor will note
if you have pain with this injection. The benefit of a discogram
is that it enables the spine surgeon to confirm which disc level
is really causing your pain. This ensures that surgery will be more
successful and reduces the risk of operating on the wrong disc.
Injections - Pain-relieving injections
can relieve back pain and give the physician important information
about the problem, as well as provide a bridge therapy.
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