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Plain X-rays of the lower back are used as a general screening tool however do not provide an adequate amount of information to make a definitive diagnosis for the majority of spinal conditions. X-rays are useful to detect gross abnormalities of the vertebral bones or demonstrate widespread degenerative changes. Instability of the spine, abnormal movements of the individual bones during normal motion can be detected using plain X-rays with the patient bending forward and backward, known as Flexion/ Extension X-rays.
MRI or Magnetic Resonance Imaging has become the standard radiographic study to diagnosis the majority of spine conditions. These imaging studies provide excellent definition of the soft tissues surrounding the spine, including the intervertebral disc, facet joints, and spinal nerves. In addition an MRI can provide views of the spine in multiple planes adding to their diagnostic power. The disadvantages of an MRI include poor visualization of bone and confined quarters required in the majority of scanners that can create significant anxiety for claustrophobic patients. MRI’s are also contraindicated in patients with certain types of metallic implants, such as a cardiac pacemaker.
CT or Computer Tomography Scans are an additional option when evaluating patients with spinal disorders. The CT, like an MRI, is a non-invasive radiographic study. The CT images provide excellent definition of the bone structure and can also provide views of the spine in multiple planes. Soft tissue structures however are not as clearly defined on a CT as they are on an MRI. CT scanning can be enhanced with the addition of a Myelogram; however a disadvantage of the CT-Myelogram is the requirement for a lumbar puncture and injection of dye within the spinal canal that can be a source of discomfort for patients.
Other potential radiographic studies that may be used in the evaluation of patients with low back pain include Discography and Nuclear Bone Scans. The utility of these studies, particularly discography, is debatable and neither is universally accepted as a standard diagnostic technique in the evaluation of patients with low back pain.
Initial evaluation consists of a detailed history and physical examination intended to detect any serious conditions, such as a fracture, tumor, infection, or abdominal disease that may present with low back pain. Serious conditions presenting only with back problems however are relatively rare. In the absence of any evidence pointing to one of the more serious conditions, no further work-up is necessary for patients presenting with a single sudden episode of back pain. The medical treatment of these patients is similar. Radiographic evaluation of patients with complaints of low back pain is reserved for individuals who experience continued pain despite conservative measures, present with repeated episodes of pain, or manifest weakness/sensory involving one or both of the lower extremities. These tests are intended to help devise a treatment plan in patients who are potential candidates for surgery.
