Before a health care professional can diagnose the condition and design a treatment plan, a complete history and physical examination are necessary. There are so many possible internal causes of pain; it is important to determine what is and is not causing the problem. After the physician has a better idea of what is causing your discomfort, diagnostic tests of may be recommended. A complete physical history of your condition is important because it helps your doctor understand: when the pain began, anything that could have caused an injury, your lifestyle, physical factors that might be causing the pain, and your family history of similar problems. After taking your history, the physician will give you a physical examination. This allows the doctor to rule out possible causes of pain and try to determine the source of your problem. The areas of your body that will be examined depend upon where you are experiencing pain – neck, lower back, arms, legs, etc.
You may be asked to take a variety of diagnostic tests. The tests are chosen based upon what your physician suspects is the cause of your pain. These are the most common diagnostic tests:
An X-ray is a painless process that uses radioactive materials to take pictures of bone. If your doctor suspects vertebral degeneration, X-rays can be used to verify a decrease in the height of space between discs, bone spurs, nerve bundle sclerosis (hardening), facet hypertrophy (enlargement), and instability during flexion or extension of limbs. X-rays show bones, but not much soft tissue, so they will definitely be used if fractures, infections, or tumors are suspected.
CAT Scans (Computer Assisted Tomography)
The CAT scan is an X-ray test that is similar to both the MRI and a regular X-ray, because it can show both bones and soft tissues. CAT scans are also able to produce X-ray “slices” taken of the spine, allowing each section to be examined separately. The scan forms a set of cross-sectional images that can show disc problems and degeneration of bones, such as bone spur formation or facet hypertrophy (enlargement). CAT scan images are not as clear as either X-rays or an MRI. To make the soft tissues easier to see, the CAT scan it is often combined with a myelogram.
MRI Scan (Magnetic Resonance Imaging)
The MRI scan is a fairly new test that does not use radiation. By using magnetic and radio waves, the MRI creates computer-generated images. The MRI is able to cut through multiple layers of the spine and show any abnormality of soft tissues, such as nerves and ligaments. The test also can be used to verify loss of water in a disc, facet joint hypertrophy (enlargement), stenosis (narrowing of spinal canal), or a herniated disc (protrusion or rupture of the intervertebral disc).
During this test, a special X-ray dye is placed into the spinal sac. This will require a spinal tap to be performed by the doctor. This procedure is performed by inserting a small needle in the lower back and into the spinal canal. Through the needle, dye is injected which mixes with the spinal fluid. The dye shows up on X-rays . X-rays are taken as the patient is titled to show the flow of the dye through the spinal region, helping doctors determine if there is any unusual indentation or an abnormal shape.
Discography involves introducing a fine needle through the skin and muscles of the back directly into the intervertebral disc with the patient awake. The location of the needle tip is verified by X-Ray imaging. Once the position is confirmed a small quantity of special dye (contrast media) is injected into the disc. The injection increases the pressure inside the disc and if this maneuver reproduces the patient’s pain the test is considered positive. With X-Ray imaging, the outline of the nucleus pulposus in the disc can be visualized. Often a CT Scan is obtained after the discogram to clearly see the status of the disc and degree of dye leakage.
EMG/SSP (Electrodiagnostic Study)
An electromyogram (EMG) is a test that looks at the function of the nerve roots leaving the spine. The test is done by inserting tiny electrodes into the muscles of the lower extremity. By looking for abnormal electrical signals in the muscles, the EMG can show if a nerve is being irritated, or pinched as it leaves the spine.
The bone scan works by injecting a radioactive chemical, sometimes called a “tracer”, into the bloodstream through an IV. The chemical will attach itself to any areas of bone that are undergoing rapid changes. A special camera takes pictures of the area of the skeleton where the problem lies. A bone scan is very useful when it is unclear exactly where the problem is in the skeleton. After locating the problem areas, other tests can be done to show more aspects of those specific spots.
Further lab tests may be done to check for problems that are not related to deterioration of the spine. Other testing can help determine the presence of serious problems such as: an infection, arthritis, cancer, or an aortic aneurysm. The most frequent lab test is blood sampling.