Functional Medicine | Get Healthy Now, Naturally | Alternative Health Information Functional Medicine | Get Healthy Now, Naturally | Alternative Health Information Functional Medicine | Get Healthy Now, Naturally | Alternative Health Information Functional Medicine | Get Healthy Now, Naturally | Alternative Health Information Your Medical Detective



Back Pain Guide 3

Ronald Grisanti D.C., D.A.B.C.O., D.A.C.B.N., M.S.
Print Page

Diagnostic Tests

You may be asked to take a variety of diagnostic tests. The tests are chosen based upon what your physician suspects is the cause of your pain. These are the most common diagnostic tests:

X-rays

An X-ray is a painless process that uses radioactive materials to take pictures of bone. If your doctor suspects vertebral degeneration, X-rays can be used to verify: a decrease in the height of space between discs, bone spurs, nerve bundle sclerosis (hardening), facet hypertrophy (enlargement), and instability during flexion or extension of limbs. X-rays show bones, but not much soft tissue, so they will definitely be used if fractures, infections, or tumors are suspected.

During X-rays, you will be asked to lie very still on a table and hold certain positions while photographs are taken of your spine.

MRI Scan (Magnetic Resonance Imaging)

The MRI scan is a fairly new test that does not use radiation. By using magnetic and radio waves, the MRI creates computer-generated images. The MRI is able to cut through multiple layers of the spine and show any abnormality of soft tissues, such as nerves and ligaments. The test also can be used to verify: loss of water in a disc, facet joint hypertrophy (enlargement), stenosis (narrowing of spinal canal), or a herniated disc (protrusion or rupture of the intervertebral disc).

During an MRI test, you lie on a table that slides into a machine with a large, round tunnel. The machine's scanner then takes many pictures that are watched and monitored by a technician. Some newer MRI machines, called Open MRIs, are likely to be more comfortable for patients who experience claustrophobia. The procedure takes 30-60 minutes.

CAT Scans (Computer Assisted Tomography) The CAT scan is an X-ray test that is similar to both the MRI and a regular X-ray, because it can show both bones and soft tissues. CAT scans are also able to produce X-ray "slices" taken of the spine, allowing each section to be examined separately. The scan forms a set of cross-sectional images that can show disc problems and degeneration of bones, such as bone spur formation or facet hypertrophy (enlargement). CAT scan images are not as clear as either X-rays or an MRI. To make the soft tissues easier to see, the CAT scan is often combined with a myelogram.

Like an MRI, with a CAT scan you will lie on a table that slides into a scanner. The scanner is essentially an X-ray tube that rotates in a circle taking many pictures. The procedure takes 30-60 minutes.

Myelogram

A myelogram is an older test that is used to examine the spinal canal and spinal cord. During this test, a special X-ray dye is placed into the spinal sac. This will require a spinal tap to be performed by your doctor. This procedure is performed by inserting a small needle in the lower back and into the spinal canal. Through the needle, dye is injected which mixes with the spinal fluid.

The dye shows up on X-rays. Therefore, when the X-ray is taken, the dye outlines the spinal cord and nerve roots so that disc and bone spur problems can be seen.

To conduct the myelogram, the patient lies on a tilting table. As the table tilts, the movement of the dye shows the outline of the spinal sac. X-rays are taken as the patient is titled to show the flow of the dye through the spinal region, helping doctors determine if there is any unusual indentation or an abnormal shape. This indentation could be from a herniated or bulging disc, lesions, tumors, or injury to the spinal nerve roots.

The myelogram is often combined with a CAT scan to get a better view of the spine in cross section.

In many cases, the MRI has replaced both the myelogram and the CAT scan. Sometimes the myelogram still shows the problem better than the MRI, but today it is used less frequently than the MRI.

Bone Scan

A bone scan can be used to locate any problem areas of the spine. The bone scan works by injecting a radioactive chemical, sometimes called a "tracer", into the bloodstream through an IV. The chemical will attach itself to areas of bone that are undergoing rapid changes. Over a period of several hours, a lot of the tracer accumulates in the problem area(s).

A special camera is then used to take pictures of the skeleton. The chemical tracer is radioactive, and therefore sends out radiation that can be captured by the camera. Specific problem areas show up on the film as dark spots or "hotspots".

A bone scan is very useful when it is unclear exactly where the problem is in the skeleton. The ability to take a picture that lights up the area where the problem seems to be coming from allows the doctor to pinpoint where to look next. After locating the problem areas, other tests can be done to show more aspects of those specific spots. The bone scan can identify problem areas such as bone tumors and compression fractures. A bone scan can also be used to determine bone density and the bone-thinning condition of osteoporosis.

EMG/SSP (Electrodiagnostic Study)

An electromyogram (EMG) is a test that looks at the function of the nerve roots leaving the spine. The test is done by inserting tiny electrodes into the muscles of the lower extremity. By looking for abnormal electrical signals in the muscles, the EMG can show if a nerve is being irritated or pinched as it leaves the spine.

Think of how you test the wiring on a lamp. If you place a working bulb into the lamp, and the bulb lights up, you assume that the wiring is okay. However, what if the bulb does not light up? You can safely assume that something is probably wrong with the wiring, like the lamp is unplugged, or a short circuit has occurred. By using the muscles like the light bulb in the lamp, the EMG is able to determine the condition of the nerves that supply those muscles, just like the wiring on the lamp. If the EMG machine finds that the muscles (the light bulb) are not working properly, the doctor can assume that the nerves (the wiring) must be getting pinched somewhere.

Facet Joint Block

Like any joint in the body, facet joints can cause pain if they are irritated or inflamed. The facet joint block is a procedure where a local anesthetic medication (such as lidocaine or Novocain) is injected into the facet joint. This same type of medication is used by a dentist to numb your jaw, or a doctor to sew up a laceration. The lidocaine actually numbs the area around the facet joint. If all your pain goes away, the doctor can assume that the facet joint is a problem.

Laboratory Tests Further lab tests may be done to check for problems that are not related to deterioration of the spine. Other testing can help determine the presence of serious problems such as: an infection, arthritis, cancer, or an aortic aneurysm. The most frequent lab test is blood sampling.

Back Pain Guide Part 4 Continued



Before starting any self treatment Dr. Grisanti recommends that you consider consulting with a doctor trained in functional medicine. Visit www.FunctionalMedicineUniversity.com to find doctors thoroughly trained in functional medicine

Functional medicine embraces the totality of the regulatory functions of the body. It encompasses all of the biophysical, biochemical, enzymatic, endocrine, immunological, and bioenergetic regulatory capacities.

Ronald Grisanti D.C., D.A.B.C.O., D.A.C.B.N., M.S.