Low Back Pain X-ray Findings

Low Back Pain X-Ray FindingsMost of us occasionally suffer from lower back pain due to typical triggers such as pinched nerve, incorrect posture, physical exertion, sports related sprains and strains or even a bad flu.  That kind of back pain is usually transitory and is commonly alleviated by over-the-counter medication, bed rest and time. In most cases, even a visit to the doctor is unnecessary. Within a few days, the pain is gone and we can resume our normal lives.

But lower back, or lumbosacral spine, pain has no obvious cause, is unrelenting and it impedes your ability to function in everyday activities, a visit to a back specialist is imperative in order to correctly diagnose the source of the pain and to receive proper treatment.  

At your appointment, your specialist will assess your condition by asking about your general health, lifestyle, activity level and history of the pain.  He or she will conduct a thorough physical examination that will most likely include the testing of nerve function and muscle strength in certain parts of the leg or arm and the testing for pain in certain positions.  All this will help him to pinpoint the source and scope of the pain and to formulate a diagnosis and treatment plan.  

However, in cases where a clear diagnosis is not attained after this type of preliminary clinical investigation or if the specialist suspects that you may be suffering from a specific condition such as a herniated disc or degenerative disc disease (DDD), a much more involved study, including the use of more advanced diagnostic tools, will be prescribed.  It is important to understand that receiving a correct diagnosis is necessary in order to allow the back specialist to formulate the most effective treatment course for the patient.

There are several relatively painless tests a specialist can prescribe to help formulate as accurate a diagnosis as possible.  These tests include x-rays (your back specialist will most likely request an x-ray or MRI to diagnose your lower back pain), discography, bone scans, electromyography and lab tests

X-ray, CT and MRI Scans

X-rays of the spine are the most commonly used test to identify abnormal conditions of the spine including narrowed disc space, bone spurs, fractures, scoliosis, spina bifida and arthritis. CT scans are often used to determine how much space is available for the nerve roots and to evaluate bone structure. MRI scans can be used to detect herniation, bulging discs, and nerve root compression.  

There are 4 major types of specific x-rays that are used to determine the exact source and location of the pain on the spine:

Cervical spine X-rays are used to take pictures of the 7 neck (cervical) bones.

Thoracic spine X-rays concentrate on the 12 chest (thoracic) bones.

Lumbosacral spine X-rays are the most commonly used to determine the cause of lower back pain.  These x-rays take pictures of the 5 bones of the lower back (lumbar vertebrae) and a view of the 5 fused bones at the bottom of the spine (sacrum).

Sacrum/coccyx X-rays take a detailed view of the 5 fused bones at the bottom of the spine (sacrum) and the 4 small bones of the tailbone (coccyx).

The most common spinal X-rays are C-spine films which take pictures of the cervical vertebrae and LS-spine films which concentrate on the lumbosacral vertebrae.

It should be noted that lower back x-ray findings are not always conclusive.  Interestingly, some of the results that can be seen on an x-ray, such as abnormal curves of the spine, abnormal wear on the cartilage and bones of the lower spine, cancer, fractures, osteoporosis and slippage of the part of the spine known as spondylolisthesis, are not always the actual cause of the back pain. Unfortunately, there are several problems of the lower spine that cannot necessarily be diagnosed using a lumbosacral x-ray including sciatica, slipped or herniated discs or a narrowing of the spinal column known as spinal stenosis.

Electromyography (EMG, Myogram, or Nerve Conduction Test)

EMG is a neurodiagnostic test that can be used to assess the health and function of the muscles and the nerves that control the muscles. This test is often used to detect nerve damage.

Discography (Discogram)

A discography involves the injection of a contrast dye into the invertebral discs and then viewing the discs using a special type of x-ray. Discography is usually used to determine which disc is causing pain when surgery is being considered.  This test is somewhat controversial and is only used in rare cases.

Bone Scan

A bone scan consist of injecting a small amount of radioactive material into the blood stream that travels through the body and collects in the bones. In this test, a computer scanner is used to detect signs of arthritis, fracture, or infection.

Laboratory Tests  

Urine and blood tests are also often requested in order to rule out other conditions that may cause lower back pain, such as kidney infections or rheumatoid arthritis.

It is important to note that the test findings on an MRI scan, or other diagnostic tests, are not in and of themselves a definitive diagnosis of the source of your lower back pain.

An experienced practitioner will take all the results from the clinical evaluation and match them with any other tests the patient underwent.  Only after thorough examination of all these components can the specialist make a well-founded diagnosis and prescribe a treatment protocol that will allow the patient to resume a normal and productive life.