Exams and Tests

The doctor will take a complete medical history and perform a physical examination.

• This history should include other illnesses, prior spine problems, any injuries, duration and type of symptoms, and response to treatments. The examination should include a spine examination, testing of basic nerve functions, an abdominal examination, and a general screening.
  
  
• Often no diagnostic tests are needed for adequate treatment. In certain cases, imaging studies or laboratory tests of blood and urine may provide your doctor further information necessary to establish an adequate diagnosis. If needed at all, they may not be necessary immediately. Sometimes they are ordered later if basic treatments fail to improve your condition.
  
  
• If imaging studies are taken, they are often one of the following:
  
  
  • Plain x-rays (and even CT scans) cannot depict a prolapsed disk and can only identify bony abnormalities. These x-rays are best used to evaluate back pain that is from causes other than a prolapsed disk, such as bony displacement, tumor, or broken bone. Most young or middle-aged people without a history to suggest trauma or tumor are best served without the expense and radiation associated with obtaining these x-rays. In most cases, the bones seen on x-ray are normal.
    
    
  • More specialized tests include an MRI or myelogram (which includes injecting dye into the spinal column) of the back. These are better for diagnosing a prolapsed disk and the way the specific nerve is affected. In the absence of signs or symptoms suggesting severe nerve damage, however, these studies are very rarely indicated or ordered early in the course of the evaluation. This is because of cost, availability of the test, and the fact that the findings rarely affect initial treatment decisions. Your doctor may obtain these tests after a course of treatment fails to provide you relief.
    
    
  • Bone scans can detect infection, healing fractures, or tumors. This test is essentially never ordered as part of an emergency evaluation and generally needs to be arranged by your doctor in advance.