Diagnostic Tests

Diagnostic Tests

Nearly every one of us will suffer from back pain at least once in our lives. The Mayo Clinic explains that back pain is one of the most common reasons that we visit the doctor and stay home from work. Though many of us will experience back problems, considerably fewer of us will actually undergo spinal surgery. Because of the risks associated with many spine surgeries, most surgeons work to limit surgeries by prescribing exercise, chiropractic care, physical therapy, and even pain relievers in all but the most severe cases. Deciding whether to pursue back surgery will involve talking to your general practitioner and a spine specialist.  Ultimately, the decision to undergo spine surgery will be yours.    

How will the back surgeon determine if I am a candidate for surgery?

To determine whether or not you are a candidate for back surgery, especially after completing a regimen of less-invasive, restorative exercises or taking pain killers, your surgeon may run a series of diagnostic tests. These tests, corroborated with your own experiences and explanations of your pain and symptoms, will help your spine specialist determine the most appropriate surgery. 

Some common diagnostic tests include x-rays, CT scans, MRI scans, blood and urine tests, bone scans, and nerve studies. Each of these tests, detailed below, may help the surgeon determine the cause of your back problems.  Good surgeons will always use your symptoms and descriptions (the clinical diagnosis) alongside the results of the diagnostic tests, for there are times when the results of the diagnostic tests do not match the clinical diagnosis. 

  • X-Rays.  X-rays identify broken or fractured bones, misaligned vertebrae, and may allow the surgeon to see whether or not you suffer from arthritis.  Because x-rays only show bone, they will not help the specialist identify problems with nerves or discs. 
  • CT scans. Unlike x-rays, CT (computerized tomography) scans will reveal problems not only with bones, but also the soft tissues in your body including muscles, tendons, nerves, ligaments, and blood vessels, making it more useful than an x-ray to determine whether there are problems with the discs in your back.  Often, CT scans require that the patient take a contrastive agent, usually orally or through an injection, that will highlight abnormalities on the scans.  CT scans provide the surgeon with a series of images of the back, and the surgeon can look at the images in the series individually or as a whole.  The whole series of images provides a 3-D representation of the spine and surrounding tissues that may reveal any abnormalities in the musculo-skeletal development of the back.   
  • MRI scans.  Like CT scans, MRI (magnetic resonance imaging) scans can be used to produce 3-D images of the back.  Instead of using the x-ray technology that CT scans use, MRIs use magnets and radio waves to produce the images.  Using magnets and radio waves allows the radiologist to see the body from multiple angles, rather than just the one that the CT scan offers. MRIs are most commonly used to image the brain and spinal cord. They are used to determine whether patients suffer from multiple sclerosis, tumors, spinal cord injuries, and herniated discs.  As during CT scans, some patients may take a contrastive agent to help abnormalities appear more clearly on the scans.
  • Blood and urine tests. Occasionally, urinary tract infections cause lower back pain.  These infections are often diagnosed through simple urine tests. Other infections, revealed through blood tests, may also be the cause of back pain.
  • Bone scan.  Surgeons and radiologists generally use bone scans less often than they do x-rays, CT scans, and MRIs. Bone scans are used when other diagnostic tests do not explain the patient’s bone pain. Bone scans use nuclear imaging specifically to track disease, like cancer or infection, in the bone that a traditional x-ray will not show. They can also reveal the location of arthritis. 
  • Nerve studies.  EMG (electromyography) focuses specifically on measuring the health of muscles and the nerves that control them. Above all, EMGs measure neurological problems. In needle EMGs, a needle inserted into the muscle measures the nerve conductivity and the results are recorded on a graph.  In a nerve conduction study, surface electrodes measure and record the conductivity – including speed and strength – between two specific points.  Nerve studies may be done on patients who experience tingling, numbness, or weakness in their back muscles. The results can be used to diagnose amyotrophic lateral sclerosis and herniated discs, both of which affect and are affected by nerves in the spinal cord.

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