Diagnostic Procedures

Technological advances have made the diagnosis of disorders of the spine easier.  However, our enthusiasm for medical technology must be tempered by recognizing that deviations from what we define as normal are not necessarily associated with a specific complaint.  For example, most individuals who have bulging intervertebral discs on magnetic resonance imaging test have no symptoms associated with these alterations from normal. Therefore, any abnormality mentioned as a finding must be correlated with patient complaints to be sure that they are important.

The following is a list of common tests used by physicians to diagnose conditions affecting the spine.

Conventional x-ray

Radiography involves the use of radiation (x-rays) to creat an image of the internal structures of the body. Previous, radiographs were created by passing small highly controlled amounts of radiation through the human body, capturing the resulting image on a special type of photographic paper.  Current technology allows for the digital capture of the images without the need for film.  Solid structures block the flow of x-ray beams and appear with white shadows on images.  Bones are visualized well with conventional x-rays. Alterations in bone structure caused by fractures, arthritis, or cancer may be identified by conventional –ray techniques by medication from normal appearing bone in the corresponding portion of the spine. Digital x-ray allows for the use of smaller amounts of radiation with greater precision of images that would not have been recognized by older-x-ray methods.

Conventional Spine X-rays

What are conventional  x-rays?

Conventional x-rays of the spine use the same technology as used for chest x-rays.  Patients are positioned to allow the smallest area of exposure that allows imaging of the part of the spine under investigation.  The number of pictures taken corresponds to the best alignment of the x-ray tube with the anatomic structure.

X-rays are not required for spine pain that is 8 weeks or shorter in duration.  X-rays are indicated during this initial period if individuals have symptoms suggestive of a systemic illness (LOOK AT SYMPTOMS).  X-rays are most useful looking at the bones and joints of the spine.  Soft tissues like muscles and intervertebral discs are not visualized by this technology.

How are conventional x-rays taken?

Generally, you will be positioned on your back and on your side for an initial spine x-ray study.  X-rays taken on a 45 degree angle visualize the joints of the spine. Frequently, a frontal view of the pelvis examining the sacroiliac and hip joints will be taken while lying flat on the x-ray machine. .  If there is a concern regarding the stability of your spine, a standing x-ray of bending forward (flexion) and bending backwards (extension) will be added.