Diagnostic Tools

Effectiveness of Diagnostic Tools for Sciatica

Ben Parr — Tue, 03 Mar 2009 14:40:31 -0800

A physician answers patient questions about diagnostics tools for diagnosing sciatica.

Question: Discogram, CT scan, or myelogram for sciatica diagnosis?

Since a spinal fusion surgery eight years ago, all activities and exercise create sciatica pain. The leg numbness and tingling and aching from the sciatica are so bad they sometimes wake me at night.

Diagnostic Tools for Sciatica from a Herniated Disc

Ben Parr — Wed, 25 Feb 2009 15:25:53 -0800

A physician answers patient questions about diagnosing sciatica due to a lumbar herniated disc.

Question: Tests to determine the cause of sciatica?

I experience numbness and tingling in my leg. I have a lumbar herniated disc at L5, which is causing sciatica.

Besides an MRI, is there another test to determine if the sciatica is caused by nerve compression and to identify which nerves are being compressed?

Exercise May Help Chronic Back Pain With Unknown Cause

Ben Parr — Mon, 16 Feb 2009 13:57:59 -0800

A physician answers patient questions about exercise and treatments for chronic back pain when there appears to be no underlying cause.

Diagnostic Studies, Patient History, and Physical Exams for Spinal Fusion

Ben Parr — Fri, 23 Jan 2009 10:03:28 -0800

There are three essential aspects to understanding whether one is a good candidate for spinal fusion to treat their low back pain:

X-Ray

spine-health — Fri, 04 Jan 2008 07:54:04 -0800

Definition

Electromyogram

spine-health — Fri, 04 Jan 2008 07:52:45 -0800

Definition

An electromyogram is a diagnostic test involving the placement of small needles into the muscles to assess the electrical activity of muscle and nerve function.

An EMG showing abnormal electrical muscle activity may indicate nerve degeneration (neuropathy) from nerve root compression, disc herniation, or indicate conditions, such as muscular dystrophy and amyotrophic lateral sclerosis (Lou Gehrig disease).

Diagnostic Test or Diagnostic Study

spine-health — Fri, 04 Jan 2008 07:52:42 -0800

Definition

A diagnostic procedure is an examination to identify an individual’s specific areas of weakness and strength in order determine a condition, disease or illness. For example, in order to diagnose a herniated disc, physicians may employ Magnetic Resonance Imaging (MRI), Computer Assisted Tomography (CAT scan), and/or Electromyography (EMG) to determine if the herniated disc is impinging on a nerve root.

Synonyms and relevant terms

CAT Scan Computer assisted tomography

spine-health — Fri, 04 Jan 2008 07:52:26 -0800

Definition

A CAT scan is a diagnostic test that enables the spinal canal to be imaged and assessed for specific conditions. The scan works by shooting an x-ray beam at 160 points throughout the body and crystals opposite the beam pick up and record the absorption rates of the varying thicknesses of tissue and bone.

Evaluation of the Patient

spine-health — Wed, 12 Dec 2007 00:07:09 -0800

Candidates for manipulation under anesthesia (MUA) are selected after undergoing a detailed exam that includes an adequate history, thorough physical, and the appropriate diagnostic imaging and laboratory procedures necessary for an accurate diagnosis of the underlying condition.

Osteoporosis Diagnosis

spine-health — Tue, 11 Dec 2007 21:32:52 -0800

Diagnosis of osteoporosis

The gold standard for diagnosis of osteoporosis is dual energy x-ray absorption scan (DEXA scan). The test is performed by passing low energy x-rays through a bone (e.g. spine, hip or wrist). The test takes about ten minutes, is painless, and is associated with very limited radiation exposure. The values generated by the test can then be compared to both:

Diagnostic Tests for a Cervical Herniated Disc

spine-health — Tue, 11 Dec 2007 21:26:49 -0800

Indications and Contraindications for an MRI Scan

spine-health — Tue, 11 Dec 2007 21:16:22 -0800

The following general rules are usually considered by a physician before ordering an MRI scan for a patient.

Indications for when to get an MRI scan include:

Magnetic Resonance Imaging (MRI scan)

spine-health — Tue, 11 Dec 2007 21:16:22 -0800

An MRI scan is a completely different technology from an x-ray and CT scan and represents the single most useful imaging study available for spine surgery.

An MRI scan is particularly useful as an aid in the assessment of certain back conditions by providing detail of the spinal disc (such as for degenerative disc disease, isthmic spondylolisthesis) and nerve roots (such as for lumbar disc herniation, lumbar spinal stenosis). MRI scans are also useful to rule out tumors or spinal infections.

MRI Scan of the Spine

spine-health — Tue, 11 Dec 2007 21:16:22 -0800

Magnetic Resonance Imaging (MRI scan) was developed in the 1980's and has revolutionized our ability to see normal and abnormal spinal structures and help diagnose what causes back pain. The MRI scan is an imaging test that allows physicians to assess a patient’s spinal anatomy and investigate an anatomical cause of the patient’s back pain.

New MRI Scan Technology

spine-health — Tue, 11 Dec 2007 21:16:22 -0800

There is a lot of difference between MRI scanners. First, there is a large difference in image quality between MRI scanners.

Lumbar Discogram Technique for Diagnosis of Back Pain

spine-health — Tue, 11 Dec 2007 21:16:21 -0800

While different discographers may vary the procedure slightly, the following provides an overview of modern technique for a lumbar discogram diagnosing back pain.

History and physical exam

A nurse or other healthcare professional conducts the initial interview. All of your questions and concerns should be addressed and answered. This is the time to relate any and all horror stories you may have heard from medical (and non-medical) experts. Despite what you’ve been told, the discogram is not designed to create agony.

Dual Energy X-ray Absorptiometry (Dexa scan)

spine-health — Tue, 11 Dec 2007 21:16:21 -0800

A dexa scan is used specifically to assess a patient’s risk of fracture by detecting osteoporosis of the vertebral bodies, which is a thinning of the bones as we age and a possible source of back pain.

A dexa scan takes about ten minutes and is associated with minimal radiation exposure.

Back Pain Diagnosis Info

Diagnostic Tools

Back Pain Causes

Do I Need an MRI Scan?

spine-health — Tue, 11 Dec 2007 21:16:21 -0800

The MRI (Magnetic resonance Imaging) was developed in the 1980’s and has revolutionized treatment for patients with low back pain. An MRI scan is generally considered to be the single best imaging study of the spine to help plan treatment for back pain.

Introduction To Diagnostic Studies For Back Pain

spine-health — Tue, 11 Dec 2007 21:16:21 -0800

Diagnostic studies help identify a back injury

Diagnostic studies are used to confirm an anatomical lesion (injury) as a cause of back pain or neck pain. They are particularly useful to pinpoint the source and extent of the injury to assist in the diagnosis and development of an appropriate treatment plan for the patient's back problems.

Bone Scan

spine-health — Tue, 11 Dec 2007 21:16:21 -0800

A bone scan is sometimes performed to rule out an inflammatory process (such as a tumor or infection) or an occult fracture (small fracture not seen on an x-ray) as the cause of back pain.

A bone scan is performed by injecting a small amount of radioactive marker into an intravenous line (IV). Three hours later the patient is placed through a scanner and the radioactive marker will be concentrated in any region where there is high bone turnover.

Important Considerations for an MRI Scan

spine-health — Tue, 11 Dec 2007 21:16:21 -0800

There are a number of important factors to take into consideration for an MRI scan, including limitations with interpretation of findings and the timing of when an MRI scan should be performed.

X-Ray

spine-health — Tue, 11 Dec 2007 21:16:21 -0800

X-rays provide detail of the bone structures in the spine, and are used to rule out back pain resulting from:

Discogram to Diagnose Low Back Pain

spine-health — Tue, 11 Dec 2007 21:16:21 -0800

Similar to an SNRB and facet joint block, a discogram is a test to determine the anatomical source of lower back pain for the patient. This procedure is most frequently used to determine if degenerative disc disease is the cause of a patient’s pain (discogenic low back pain). Discograms are also performed to assist in preoperative planning for candidates for a lumbar spinal fusion.

Lumbar Discography for Back Pain Diagnosis

spine-health — Tue, 11 Dec 2007 21:16:21 -0800

Lumbar discography is an injection technique used to evaluate patients with back pain who have not responded to extensive conservative care regimens. The most common use of discography is for surgical planning prior to a lumbar fusion.

This diagnostic procedure – also called a discogram – is a controversial one.

Electromyography (EMG)

spine-health — Tue, 11 Dec 2007 21:16:21 -0800

An EMG assess the electrical activity of a nerve root and is sometimes recommended for patients with back pain. After three weeks of pressure on a nerve root, the muscle the nerve goes to will begin to spontaneously contract. Compression of a nerve will also slow electrical conduction along that nerve. EMG’s are also sometimes useful to distinguish nerve degeneration (neuropathy) from nerve root compression (radiculopathy).

How MRI Scans Work

spine-health — Tue, 11 Dec 2007 21:16:21 -0800

The MRI scan “sees” the spine by using a large magnet that stimulates (excites) the hydrogen atoms in the vertebrae (bony building blocks of the spine), spinal sac (contains the spinal cord, nerves and spinal fluid), supporting muscles and ligaments. Because the human body is mostly comprised of water (which is 2 parts hydrogen and 1 part oxygen, or H2O), an accurate picture of the spinal anatomy can be attained.

Somatosensory Evoked Potentials (SSEP)

spine-health — Tue, 11 Dec 2007 21:16:21 -0800

SSEP’s assess the speed of electrical conduction across the spinal cord and are sometimes ordered for patients with back pain. If the spinal cord is significantly pinched, the electrical signals will travel slower than usual.

Computerized Tomography (CT scan)

spine-health — Tue, 11 Dec 2007 21:16:21 -0800

A CT scan (see Figure 1) is essentially a fancy x-ray that can take cross section images of the body.

They provide excellent bony detail, yet through multiple views are also capable of imaging for back pain caused by specific conditions, such as:

Getting an Accurate Back Pain Diagnosis

spine-health — Tue, 11 Dec 2007 21:16:19 -0800

Back pain diagnostic techniques

Because the causes of back pain can be very complex, it is often more difficult to get an accurate diagnosis for back pain or neck pain than for other medical conditions. While some spinal diagnoses are relatively straightforward (such as tumors, infections, or fractures), for many conditions there is little agreement among spine specialists about a diagnosis.

Diagnosis of Bone Spurs

spine-health — Tue, 11 Dec 2007 21:16:19 -0800

Diagnostic evaluation begins with the clinical examination. Your health care provider should perform a detailed neurological and spine evaluation assessing for spinal nerve and spinal cord compression.

Common diagnostic tests include:

Electroconductive tests are commonly performed to document the degree and severity of spinal nerve injury. The EMG and nerve conduction test (EMG/NCV) tests will exclude peripheral nerve compression such as carpal tunnel syndrome.
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