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Spine Imaging – Why Did My Doctor Order This?

Rachel Cengia, PA-C

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If you see a doctor for a neck or back problem, he or she may order several different types of imaging to assist in determining your diagnosis and possible treatment options. It can be confusing or frustrating to undergo multiple studies if you don’t understand the reasoning behindthem. These studies are performed and interpreted by radiologists, physicians who possess specialized training in using imaging to arrive at a diagnosis.  The radiologist will prepare a report, based on the study findings, for your spine specialist.  In many cases, your spine specialist will also review the study images themself.  Here is a quick synopsis as to what a spine specialist is looking for on different types of studies:

X-ray: Basic x-rays provide the doctor with information on the bones in the neck or back. They can help show if there are degenerative changes (arthritis) and any signs of instability. They also demonstrate any fractures that may be present.

MRI: An MRI helps the specialist to better visualize the discs,  nerves and joints in your neck or back. The study shows if there is any compression on the spinal cord or individual nerves. An MRI can provide information on any tumors, cysts or fluid that may be present. An MRI should always be obtained in cases where there is persistent pain or if there are any neurological symptoms.  An MRI does not submit the patient to radiation.

CT Scan: This study gives a more in-depth view of the bones in the spine. It provides  detail that an x-ray cannot, and the doctor can look at very thin sections of the bone (across the spine or up and down) to obtain more information than x-rays can. It can be helpful to better visualize fractures, or provide more information for surgical planning. It can also help after surgery to visualize any hardware that has been placed, such as in a fusion and to monitor if the anticipated fusion is taking place.

CT Myelogram:  This is a CT scan with the addition of something called “contrast.” Contrast is a dye that is injected through  a spinal injection to better visualization the contents of the spine.  It may be ordered for someone who can not undergo an MRI (usually due to a pacemaker or other implants). It can also be helpful after surgery to visualize both nerves and hardware.

Discogram: A discogram is a study that may be used to help determine which disc may be causing back pain.  This study can be helpful not only in diagnosing the cause of back pain but can limit the extent of any future surgery by identifying painless discs that might look abnormal on MRI.  A discogram is not performed unless your spine surgeon feels that it would be helpful.  There are specific indications for ordering one, and this is a study that should be discussed with your doctor.

There are many different studies that can be ordered by your doctor to help determine your diagnosis and best treatment options. Discussing the need for and results of these studies with your physician is an important part of your care.

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