When you are experiencing back and/or neck pain you will find that in order
to figure out where you pain is coming from & hopefully the cause requires a
variety of diagnostic methods, which may include (in alphabetical
order):
Medical History & Physical
A thorough medical history and physical exam many times can identify any
dangerous conditions or family history that may be associated with the pain. The
patient describes the onset, site, and severity of the pain; duration of
symptoms and any limitations in movement; and history of previous episodes or
any health conditions that might be related to the pain. The physician will
examine the back and conduct neurologic tests to determine the cause of pain and
appropriate treatment. Blood tests may also be ordered. Imaging tests may be
necessary to diagnose tumors or other possible sources of the pain.
A variety of diagnostic methods are available to confirm the cause of low
back pain:
X-ray
X-ray imaging includes conventional and enhanced methods that can help
diagnose the cause and site of back pain. A conventional x-ray, often the
first imaging technique used, looks for broken bones or an injured vertebra. A
technician passes a concentrated beam of low-dose ionized radiation through the
back and takes pictures that, within minutes, clearly show the bony structure
and any vertebral misalignment or fractures. Tissue masses such as injured
muscles and ligaments or painful conditions such as a bulging disc are not
visible on conventional x-rays. This fast, painless procedure is
usually performed in a doctor’s office or at an outpatient surgery center.
Discography
Discography involves the
injection of a special contrast dye into a spinal disc thought to be causing low
back pain. The dye outlines the damaged areas on x-rays taken following the
injection. This procedure is often suggested for patients who are considering
lumbar surgery or whose pain has not responded to conventional treatments.
Bone Scans
Myelograms also enhance the diagnostic
imaging of an x-ray. In this procedure, the contrast dye is injected into the
spinal canal, allowing spinal cord and nerve compression caused by herniated
discs or fractures to be seen on an x-ray.
CT Scan
Computerized tomography (CT) is a quick and painless process used when
disc rupture, spinal stenosis, or damage to vertebrae is suspected as a cause of
low back pain. X-rays are passed through the body at various angles and are
detected by a computerized scanner to produce two-dimensional slices (3 mm each)
of internal structures of the back. This diagnostic exam is generally conducted
at an imaging center or hospital.
MRI
Magnetic resonance imaging (MRI) is used to evaluate the lumbar region
for bone degeneration or injury or disease in tissues and nerves, muscles,
ligaments, and blood vessels. MRI scanning equipment creates a magnetic field
around the body strong enough to temporarily realign water molecules in the
tissues. Radio waves are then passed through the body to detect the “relaxation”
of the molecules back to a random alignment and trigger a resonance signal at
different angles within the body. A computer processes this resonance into
either a three-dimensional picture or a two-dimensional “slice” of the tissue
being scanned, and differentiates between bone, soft tissues and fluid-filled
spaces by their water content and structural properties. This noninvasive
procedure is often used to identify a condition requiring prompt surgical
treatment.
EMG
Electrodiagnostic procedures include electromyography (EMG), nerve
conduction studies, and evoked potential (EP) studies. EMG assesses the
electrical activity in a nerve and can detect if muscle weakness results from
injury or a problem with the nerves that control the muscles. Very fine needles
are inserted in muscles to measure electrical activity transmitted from the
brain or spinal cord to a particular area of the body. With nerve conduction
studies the doctor uses two sets of electrodes (similar to those used during an
electrocardiogram) that are placed on the skin over the muscles. The first set
gives the patient a mild shock to stimulate the nerve that runs to a particular
muscle. The second set of electrodes is used to make a recording of the nerve’s
electrical signals, and from this information the doctor can determine if there
is nerve damage. EP tests also involve two sets of electrodes — one set to
stimulate a sensory nerve and the other set on the scalp to record the speed of
nerve signal transmissions to the brain.
Bone Scans
Bone scans are used to diagnose and monitor infection, fracture, or
disorders in the bone. A small amount of radioactive material is injected into
the bloodstream and will collect in the bones, particularly in areas with some
abnormality. Scanner-generated images are sent to a computer to identify
specific areas of irregular bone metabolism or abnormal blood flow, as well as
to measure levels of joint disease.
Thermography
Thermography involves the use of infrared sensing devices to measure small
temperature changes between the two sides of the body or the temperature of a
specific organ. Thermography may be used to detect the presence or absence of
nerve root compression.
Ultrasound Imaging
Ultrasound imaging, also called ultrasound scanning or sonography,
uses high-frequency sound waves to obtain images inside the body. The sound wave
echoes are recorded and displayed as a real-time visual image. Ultrasound
imaging can show tears in ligaments, muscles, tendons, and other soft tissue
masses in the back.
