Diagnosing Low Back Pain
The diagnosis of back pain isn't always easy. The human spine is very complex, so it can be difficult to pinpoint the exact cause of low back pain or other symptoms. Additionally, other factors like depression, anxiety, or stress can contribute to the onset of back pain.
The following are various diagnostic tools that can be used to try to identify the source(s) of low back pain:
Physical Examination: The diagnosis of low back pain begins with a complete physical examination. Your doctor will examine your back for flexibility and range of motion. This often involves testing the strength of your muscles and your reflexes to make sure that they are still working normally. You may be asked to fill out a diagram that asks you where your symptoms of pain, numbness, tingling and weakness are occurring.
X-rays: A series of x-rays is usually ordered for a patient with back pain. X-rays involve a painless, non-invasive imaging process used for obtaining images of the spine. If disc degeneration is present, the x-rays will often show a narrowing of the interevertebral discs between the vertebral bodies, which indicates the discs have become very thin or have collapsed. Bone spurs, called osteophytes, can also form around the edges of the vertebral bodies and around the edges of the facet joints. As the disc collapses and bone spurs form, the space available for the nerve roots can also start to shrink.
MRI (magnetic resonance imaging): MRI is a non-invasive technique for imaging the spine that involves rotating a magnet around the body. It is used to image soft tissue structures, such as the spinal cord, intervertebral discs, etc. The MRI is the single most useful test available for diagnosing spinal disorders. MRI images are used to examine intervertebral disc height, hydration and a disc's ability to exchange nutrients with its neighboring vertebrae.
CAT Scan (computed axial tomography scan) [also called a CT scan (computed tomography scan)]: This is another painless imaging technique that utilizes a computer to produce detailed three-dimensional images of a body from a collation of cross-sectional X-rays taken along an axis. Of all the imaging techniques that are currently available, the CAT scan is best able to produce images of bone. The technology used in CAT scans is identical to that used in X-rays.
Functional Anaesthetic Discography™ (F.A.D.™) Procedure: The F.A.D.™ Procedure is a novel way to aid in diagnosing the source of low back pain. Discogenic pain is diagnosed by evaluating a patient's response to anesthetic injections into suspected intervertebral discs while performing their typical pain-eliciting activities. The procedure enables various discs to be assessed independently to determine the source of a patient's low back pain. Judging by the effectiveness of the anesthetic in relieving pain and increasing range of motion, the specific disc(s) producing back pain can be identified. This diagnostic information can be used to help determine appropriate treatment options for the patient.
Facet or Sacro-Iliac Joint Injections: Local anesthetic injections into these joints are used to evaluate these joints as sources of low back pain. Judging by the effectiveness of the anesthetic in relieving pain, a specific joint(s) producing back pain can be identified.
Provocative Discography (PD): Provocative discography tries to locate the source of low back pain by attempting to provoke and reproduce typical back pain. This is done by injecting fluid and increasing the pressure within the disc(s). This procedure heavily relies on patients' subjective interpretation of the provoked pain.
Myelogram: This test procedure involves injecting a radiographic contrast media (dye) into the sac (dura) surrounding the spinal cord and nerves, and then taking X-rays of the spine. This allows the radiologist to specifically X-ray the nerve roots. In this way, any abnormalities within the spinal canal can potentially be identified to aid in the diagnosis of certain spinal problems, such as nerve compression or a disc rupture.
Bone Scan: This procedure involves intravenously injecting a small quantity of a radiographic marker into the patient, and then running a scanner over the area of concern. The scanner detects the marker, which concentrates in any region exhibiting high bone turnover. A bone scan is utilized when there is suspicion of tumor, infection, or small fractures, i.e., conditions that all result in high bone turnover.
Information on this site should not be used as a substitute for talking with your doctor. Always talk with your doctor about diagnosis and treatment information.