Back & Neck Conditions - Making The Diagnosis

How are back and neck conditions diagnosed?

The most important part of your evaluation is a physical exam and medical history performed by your doctor. For many persons, additional testing is not necessary. For selected patients, diagnostic tests may be used to help diagnose back and neck disorders. These tests may include:

• Laboratory tests: These may include tests on blood, urine, joint fluid and other body fluids. In many cases, laboratory tests are used to help rule out other diseases or injuries as the cause of your symptoms.
• X-rays: Spine X-rays provide detailed images of the bones of the spine. Spine X-rays can help detect many disorders, including fractures (breaks), tumors (abnormal masses of cells), arthritis, deformities in the curves of the spine (such as scoliosis), and osteoporosis (thinning of the bones).
• Computed tomography (CT) scan: A CT scan uses X-rays and computers to produce cross-sectional images. The CT scanner is a doughnut-shaped machine that takes multiple pictures of the body, called slices, which the computer reformats into cross-sectional images. CT scans provide excellent detail of the bones of the spine, and are helpful in diagnosing small fractures and other bone-related spinal disorders that do not show up on a spine X-ray. Narrowing of the spinal canal can also be visualized on a CT scan.
• Magnetic resonance imaging (MRI) scan: MRI uses a large magnet and a computer - rather than X-rays - to produce detailed images of organs and structures inside the body. MRI produces clear images of soft tissues, and is useful in diagnosing disorders of the brain, spinal cord and joints.
• Spinal tap: A spinal tap involves placing a needle into the spinal canal and withdrawing a sample of cerebrospinal fluid, the fluid that surrounds and nourishes the spinal cord. The fluid is examined for evidence of bleeding and/or infection.
• Myelogram: This is a special type of X-ray used to detect problems of the spinal canal, spinal cord, disks and nerve roots. A dye that helps to outline the spinal cord and nerve roots is injected into the spinal canal, after which a CT scan of the spine is taken.
• Discogram: This test is used to determine why a spinal intervertebral disc is painful. Contrast dye is injected into the disk or disks to be studied. Tears or cracks in the annulus of the disk can be visualized.
• Bone scan: A bone scan is a test that looks for areas where there is a higher than normal level of bone repair activity, also called bone turnover. Bone turnover may be caused by very small fractures (breaks), infections and cancer. During a bone scan, the patient is given a small amount of radioactive material, called a tracer, which concentrates in areas that are actively involved in bone turnover. After a waiting period, a scanning camera is moved across the patient's body. The camera is able to detect the radioactive tracer, which emits gamma rays. A computer analyzes the gamma rays to form an image.
• Electromyelogram (EMG): An EMG is used to evaluate the activity of the spinal nerve roots. The test involves placing small needles into various muscles and measuring the electrical activity. The muscles' response, which indicates the degree of nerve activity, is measured. Another test, called a nerve conduction study, often is done at the same time as an EMG. Nerve conduction studies measure how fast an impulse is transmitted from one nerve to another.