DIAGNOSING THE PROBLEM

How Is The Problem Diagnosed And Confirmed?

The patient's clinical history (the story about what has happened) is invaluable in determining the general or specific nature of the problem and what has produced it. A careful assessment of the patient's complaints provides important clues to differentiate soft tissue, muscle, or ligament problems from spinal nerve compression, or from mechanical or joint syndrome.

Next to the clinical history, the physical and neurological/orthopaedic examination is of key importance in determining the actual nature and extent of the problem. The use of a patient questionnaire is also of significant value.

What Other Diagnostic Techniques Are Used?

There are several techniques used today to evaluate back problems, including selective injections, discography, myelography, electromyography, regular x-rays, CT scans, and magnetic resonance imaging.

Sometimes a combination of these is used, such as a CT scan following the injection of a small amount of myelogram dye into the spine. An example of the diagnostic methods used to determine if a problem is being caused by instability might include a trial period using a brace, special x-rays made while the patient bends forward or backward (flexion/extension), the CT scan, and discography.

What Is A Myelogram?

A myelogram is a diagnostic test in which a special substance that has an opaque appearance on x-ray film is injected into the spinal fluid, after which x-ray films are taken. This test shows irregularities or defects of the spinal canal or spinal nerves and is helpful in diagnosing herniated discs and spinal tumors, as well as differentiating scar tissue inside and outside the canal from other problems. To avoid future problems, the dye used should be water soluble as opposed to oil based.

What Is A Regular X-ray Of The Spine?

This is the simplest of diagnostic tests; it requires no special preparation or injections. An x-ray is taken in projection front to back, from the side and/or an angle. Information obtained is limited, but it does help to reveal bony structures, congenital anomalies, fractures, degenerative changes, destructive lesions, loss of disc height, malalignments, etc.

What Is A Discogram?

This procedure involves injection of the disc space with saline (salt water) and an x-ray dye to determine the structural integrity of and the presence or absence of painful changes in the disc.

What Is A CT Scan?

The computerized tomographic (CT) scanner and its attached computer interpret x-ray shadows and print cross-sectional pictures of the spine. The final result looks like a tree trunk cut in slices to show its rings and scars. The CT scan provides a much more detailed picture of the spine than does the regular x-ray or myelogram, and has dramatically increased the physician's ability to make a more accurate diagnosis, provide appropriate treatment, and assess treatment results. Newer scans even have the ability to image the spine in three dimensions!

What Is Magnetic Resonance Imaging?

MRI is a new form of imaging which uses magnetic rather than x-ray energy to create the image. It is expected that MRI will be another powerful tool in helping to diagnose disc, muscle, and nerve tissue problems of the spine.

Table of Contents

Introduction
CAUSES OF LOW BACK PAIN
DIAGNOSING THE PROBLEM
NEXT: TREATMENT FOR LOW BACK PAIN
PREVENTING LOW BACK PAIN