If simple measures fail to provide adequate pain relief, it is reasonable to perform diagnostic tests to more accurately determine the source of the pain.
Once a precise anatomic diagnosis is made then more specific treatment options can be pursued which, hopefully, will result in symptom resolution.
This is true for both more advanced nonsurgical and surgical options.
X-rays, MRI’s, CT scans and bone (SPECT) scans represent common radiological tests to evaluate the anatomy of your spine. These tests are critically important to identify more serious conditions such a spinal fracture, tumor and infection.
When there is weakness, numbness and pain in the arm(s) or leg(s), a MRI scan is the best test to find if there is compression to a spinal nerve root or spinal cord. Common causes of nerve root compression include a herniated disc, bone spur or cyst.
These radiological studies, however, have limitations. Often they find minor abnormalities despite significant pain or multiple abnormalities of which all are not painful.
A history and physical examination by a physician may find neurologic signs in those patients with nerve root compression. This is a reasonably accurate method to determine which nerve might be the cause of pain.
However, in the absence of neurologic signs (weakness and numbness), a history and physical examination can yield a tentative, but not a definitive, diagnosis.
Physical examination is helpful to determine the level of spinal involvement and what are the potential pain generators (e.g. disc, facet, sacroiliac joint, nerve root, and muscle/ligament).
Largely, in those individuals without nerve root compression and associated pain, spine injections may assist in making an accurate diagnosis of the pain source. Even in those with nerve root pain, spine injections can be helpful to identify the precise nerve responsible for pain.
Under intermittent x-ray guidance (fluoroscopy), small caliber needles can be placed into precise locations to numb (anesthetize) potential pain generators such as a spinal nerve, joint or nerve supply to a spinal joint.
As a means of determining if the disc is the pain source, one specific diagnostic injection is used to temporarily reproduce ones similar discomfort. This test is referred to as a provocation discography.
The test essentially simulates palpation to produce pain in a tender disc vs. lack of pain with palpation in a normal or asymptomatic disc. The test involves injection of x-ray dye (contrast medium) and monitoring of pressures and pain produced during the disc injection.
When the radiological (MRI or CT) tests are used in conjunction with anesthetic injections and at times provocation discography, the source of spine and/or extremity pain can be determined in the vast majority of patients.