Diagnostic

A CAT (computer assisted tomography) scan is a type of x-ray that is actually a cross between an x-ray and an MRI (magnetic resonance imaging) scan because it shows bones and soft tissues. The CT scan creates images in "slices" that can show disc problems and degeneration of bones including bone spurs and facet hypertrophy (enlargement). CAT scan images are not as clear as x-rays or an MRI. To make the soft tissues easier to see, the CAT scan is often combined with a myelogram (my-low-gram), in which special dye is injected into your spinal canal to make the images easier to see.

Bone scans are used to locate problem areas in your spine. A radioactive chemical (sometimes called a tracer) is injected into your bloodstream. Pictures are then taken of your skeleton using a special camera that can capture the radiation of the tracer. The image will show dark areas where there is highly active bone. The dark spot is a "hot spot" where bone is changing rapidly, perhaps because of overuse, a compression fracture, a bone tumor, or osteoporosis. After locating a hot spot with the bone scan, your doctor can do other tests to make a final diagnosis.

A discogram uses x-ray and a special dye injected into the center of the injured disc(s). The dye makes the disc clearly visible on x-ray film and a fluoroscope screen. The discogram can help your doctor diagnose which disc(s) are damaged and whether you will need surgery. The discogram is better than an x-ray or myelogram for determining whether there is a disc problem, because a plain x-ray shows only the vertebrae, and a myelogram only shows whether the disc has entered the spinal canal.

EMG is short for electromyogram (elec-tro-my-oh-gram). This is a test that looks at the function of the nerve roots leaving your spine. Tiny electrodes are inserted into the muscles of your arm. If a nerve is irritated from pressure as it leaves your neck, the EMG will show abnormal signals in the muscle. Think of how you test the wiring on a lamp. If you place a working bulb into the lamp and the bulb lights up, you assume that the wiring is OK. But when the bulb does not light up, you can assume that something is probably wrong with the wiring. Either the lamp is unplugged, or there is a short circuit.

Like the light bulb in the lamp, the EMG checks your muscles to make sure the nerves that supply the muscles are working. If the EMG shows abnormal signals in your arm muscles (the light bulb) your doctor may assume that the nerves (the wiring) may be irritated or "pinched" somewhere between your neck and the muscles that were tested.

X-rays are used to show the alignment of bones and to check for fractures, tumors, and infections. Unless your doctor suspects any of these problems, you probably will not have X-rays taken on your first visit.

Getting treatment for your condition is an important first step toward controlling spine pain. The treatment and reassurance from your health-care provider can help get you on the road to recovery. Sometimes these are all that are needed to help your pain go away completely. In fact, a high percentage of people with a first experience of mild back pain become pain-free within a six to eight-week period-without treatment. Yet spine pain is not predictable most of the time. Your doctor will have a better idea of your recovery time when the medical examination is completed. The goal of treatment will be to help you begin to control your pain and to help you regain your best possible function-even when your pain hasn't gone away completely.

An MRI (magnetic resonance imaging) scan creates computer-generated images of soft tissues. Using magnetic and radio waves, these images appear as layered "slices" that show muscles, tendons, nerves, and blood vessels. The MRI can show whether a intervertebral disc has lost water content. The images can also help identify facet joint hypertrophy (enlargement), stenosis (narrowing of the spinal canal), and herniated disc (protrusion or rupture of the intervertebral disc)

A spinal tap is used to get a sample of the cerebrospinal fluid that surrounds your spinal cord. The fluid is usually very clear, and it contains proteins, sugar, and other substances that can be found in blood. It typically does not contain red blood cells or many white blood cells. A spinal tap checks the pressure and content of the fluid.

Your doctor may do a spinal tap to check for bleeding, an increase in white blood cells, an increase in protein level, or inflammation. All of these are signs that you might have an infection, a tumor, or bleeding around your brain or spinal cord. To get the fluid sample, your doctor will insert a needle into your spinal canal in the lumbar region.

After taking your history, your doctor will give you a physical examination to rule out possible causes of pain and to determine what is causing your problems. Things that your doctor will usually examine include:

• Spine motion - do you have pain when you twist, bend, or move? If so, where? Have you lost any flexibility?
• Weakness - your muscles will be tested for strength. You may be asked to push or lift your arm, hand, or leg against resistance.
• Pain - your doctor may try to determine whether certain areas of your body are sore or tender to the touch.
• Sensory changes - can you feel different sensations in certain areas of the feet or hands?
• Reflex changes - your tendon reflexes may be tested below your knee or behind your ankle.
• Motor skills - you may be asked to walk on your toes or heels.
• Special signs - your doctor may check for any "red flags" that could indicate there are problems other than with your spine or vertebrae. Some signs of other problems include tenderness in certain areas, a fever, an abnormal pulse, chronic steroid use (which can cause you to lose bone mass), or rapid weight loss.

After your physical examination, your doctor may want to do some tests to help make the diagnosis. These tests may include an x-ray, MRI scan, CT scan, and lab tests.

The X-ray image is a picture of your bones. It is a useful way to check for fractures, spine deformities, and diseases of the spine (like osteoporosis). The x-ray image shows the alignment of your spine and whether there are signs of spine instability or degeneration in the bones of your spine. Degenerative changes appear on x-ray as enlargement in the facet joints, narrowing of the space between the vertebrae, or bone spurs. Your doctor may also have X-rays taken if infections or tumors are suspected.