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Spine Health

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DIAGNOSTIC TESTS

 

Radiographs:

Sometimes referred to as “X-Rays,” this is perhaps the simplest, least expensive study that provides key information.  The overall alignment of the spine, the degree of bone mineral density (osteoporosis), and the presence or absence of instability (spondylolisthesis) may be diagnosed with this simple study.  After surgery, radiographs are used in specific postoperative intervals to assess the progress of the healing process and help us determine when it is safe to start physical therapy or advance the activity levels.  At CCSI, digital radiographs can be performed in the office, so that patients do not need to travel to outside facilities for these tests.

 

CT Scan: 

A three-dimensional radiograph, CT scans allow visualization in multiple planes.  The boney anatomy is better visualized in this modality.  

 

MRI:

The best way to visualized soft tissues is by MRI.  The spinal cord, discs, ligaments and tendons are better seen in this non-invasive test.  MRI can detect infection and subtle, non-displaced osteoporotic fractures. While open units exist for claustrophobic patients, the closed units offer superior imaging quality and are recommended by CCSI.

 

CT Myelogram:

When an MRI cannot be performed (e.g. patients with pacemakers), or when metallic implants obscure the MRI imaging results, a CT scan with myelogram contrast offers an excellent alternative imaging method.  This test requires injection of a dye material into the sac that contains the spinal cord and spinal nerves; after the injection, the patient is placed on a tilt table to help distribute the dye evenly throughout the area of the spine to be imaged, and the CT scan is done.

 

Discogram with post-discogram CT:

Done by a pain management specialist in a surgery center or hospital setting, the discogram involves using a solution of saline and dye is injected into the disc spaces in question.  The discs are sequentially pressurized in a random order not known by the patient.  When a disc level produces “concordant pain,” that is, pain that is typical of the symptoms experienced by the patient during pain flare-up periods, then this data adds to the overall clinical analysis in determining whether or not surgery should be performed on the concordantly painful level.  While there is controversy over the reliability of discograms, it is important that these results are taken into consideration with other data such as the neurological exam, radiographs, EMG studies, etc., in determining the ultimate surgical recommendation.  A CT done after the discogram provides data as to the degree of degeneration of the discs based on the distribution of the dye flow in the disc, or nucleogram.  It also confirms that the appropriate level(s) have been injected.  

 

EMG/NCV Study: 

Performed by neurologists or pain management specialists, this test is an objective way to determine how well specific nerve roots and muscle groups function.  Dysfunction may be due to entrapment of the nerve; this test helps identify the anatomic point of the entrapment or stenosis, which can occur at the level of the nerve root due to a disc herniation, or anywhere along the length of the nerve into the extremities.  This test may come back normal in the presence of an entrapment or compromise in nerve function if the nerve deterioration has not progressed to the point that it is detectable by this study modality.