What is the need for investigations in back pain ?
Back pain can occur because of numerous causes ranging from a trivial muscular stiffness to spinal cord or nerve compression.
The common clinical tests for back pain, like SLR (straight leg raising), neurological examination, etc., can only give clues towards the diagnosis but the results cannot be interpreted with certainty and accuracy.These are more helpful in mapping the level and result of the disease and response to treatment rather than diagnosis of the disease.
Prolonged pressure on nerves or spinal cord causes it to degenerate and gives rise to paralysis of both lower limbs, which is not an acceptable outcome and can be easily prevented if diagnosed early and accurately.
Spine surgery requires pin-pointed information regarding the current status of the structures of the affected part of the back.
Spine surgery carries high risk of deterioration of the present condition of a person. Hence, the true need of the surgery has to be justified with an accurate confirmation of the presence of the spinal disease.
What are the common investigations done for back pain ?
X-ray is a primary investigation done in every patient of back pain. It helps to rule out common diseases, like vertebral arthritis, fracture, collapse or dislocation; narrowing of inter-vertebral disc space and bony deformities (kyphosis, scoliosis, etc.).
CT Scan is a specialized form of x-ray in which the 3-dimensional orientation of a bony lesion can be seen. It is especially useful for diagnosis of fractures and dislocations of bones (here vertebrae), which are missed on x-ray examination.
MRI is a radiation free imaging technology which uses magnetic fields for 3-dimensional visualization of body tissues. It is more beneficial for soft tissue diseases like prolapsed inter-vertebral disc, bone tumors, ligament tears, and so on. However, its high costs prohibits its use in every patient and is used selectively as per the discretion of the orthopedist. In the presence of muscle weakness or loss of sensations of any part of body, secondary to back pain, it is mandatory to do an MRI to diagnose and prevent progression of the disability.
Bone Scan is a functional image of a tissue. In this, a substance, which binds to a particular tissue of interest and is visible on x-ray, is injected in the blood of the patient. This is followed by a sequence of x-rays, which check the function of the tissue of interest. It basically checks the ability of the tissue of interest (here bone), to perform its own function. Bone scan is particularly helpful in diagnosis of bone tumors and infections. It is sometimes also used for diagnosis of minute fractures in vertebrae, which are not visible on x-rays and CT scans.
An orthopedic surgeon trained in JJ Group of Hospitals and Grant Medical College. I have worked in this field for the past 3 years and have significant clinical experience to guide students and patients on any topic in orthopedics.
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