Diagnosis of stenosis
Visual examinations performed to diagnose patients with various types of spinal stenosis include:
- Magnetic resonance imaging (MRI)
- Computed tomography with myelogram
Sometimes more than one test may be required. Conventional CT scans can better identify the causes of spinal stenosis, but cannot provide the same detailed information about the causes of soft tissue stenosis, such as disc bulges, disc herniations, and ligament hypertrophy. Due to this changing picture, the symptoms of spinal stenosis vary and a physical examination will usually not show a neurological deficit or motor weakness.
Some medical centers use “upright” magnetic resonance imaging (MRI) to lengthen the flexion and MRI of the spine to identify dynamic changes in the spine and canal size. Although the effectiveness of these tests is still being studied, it is possible to find pertinent information with such tests.
To diagnose spinal stenosis, your doctor will ask you what your current symptoms are, may ask you to discuss your medical history, and perform several physical examinations to determine the cause of your symptoms.
These tests include the following:
- X-ray – This image will show bone changes, such as bone spikes, that may cause narrowing of the space in your spinal canal. It should be noted that each X-ray exposes you to a small amount of radiation that is not dangerous to your health.
- Magnetic Resonance Imaging (MRI) – uses a powerful magnet and radio waves to produce cross-sectional images of your spine. The test may detect damage to the discs and their ligaments, as well as the presence of tumors in your spine. That this image can show where your nerves are compressed is quite valuable.
- CT or CT myelogram – if you are unable to get an MRI, your doctor will recommend that you have a computed tomography (CT) scan, which is a combination of X-rays taken from different angles to get detailed cross-sectional images of your body. In a CT myelogram, the scan is done after an injection of a safe contrast fluid that will outline your spinal cord along with the nerves and be able to show where the herniated discs, bone spines, or tumors are.
How is discopathy diagnosed?
Discopathy is a disease that can occur with age and affects one or more intervertebral discs. It manifests itself with back pain and it is important to treat it as early as possible to avoid complications. When working on a diagnosis, your spine specialist (surgeon) will ask you about the symptoms you have been experiencing recently, the medicines you have taken or are still taking, and what their effects are.
Typical questions for the diagnosis of degenerative disc diseases
- When did your pain first appear?
- What did you do when your pain started?
- What did you do to relieve it?
- Does the pain stay in one place or move to other parts of your body?
- Is there anything that reduces or worsens it?
Physical and neurological examinations
It is very likely that your doctor will conduct physical and neurological examinations.
- In the physical test, he will monitor your posture and range of motion, which means how well you can move certain joints and your overall physical condition, and will note any movement that causes you pain. Your doctor will look at your spine and document any abnormalities
- During the neurological examination, he will test your reflexes, your muscle strength, other nervous changes and the spread of your back pain to other parts of your body. This examination is important in cases of degenerative disc disease because your nerves may be affected.
Imaging diagnosis of the spine
In order to detect discopathy, you will need to have several visual tests, such as an X-ray, to help your surgeon “see” the bones in your spine. This diagnosis is quite effective for detecting:
- Narrowed spinal canals (spinal stenosis)
- Bone spurs (osteophytes)
Your surgeon will also ask for some standard X-rays. A side photo will be taken, which is called a side view. You will take another, “direct” photo, which can be taken both from the front and from the back.
In the “standard x-ray”, the doctor will look for vertebral curvature, scoliosis, fracture, or other spinal problems that may have come with the discopathy.
Your surgeon may order flexion and X-ray dilation to assess the stability of your spine and the range of motion, in terms of how well your joints are moving. Your doctor will make you lean forward (flexion) and backward (extension) to take these x-rays.
Computed tomography or magnetic resonance imaging (MRI) may be needed. The aforementioned tests are more effective than X-rays in showing the soft tissues in the spine and can help identify problems such as a swollen disc or herniated disc.
A CT scan is helpful because it is easier to see the bones and nerves so that your surgeon can clearly see if a bone spike has pinched a nerve.
If he suspects nerve damage from degenerative changes in your spine, he may order a special test called electromyography (EMG) to measure how quickly your nerves are responding.
In order to diagnose degenerative disc disease, additional tests may be needed:
- Bone scans – To help your doctor detect a problem in your spine, which may be osteoarthritis, fractures or infections, you may need to have a bone scan. You will be injected with a small amount of radioactive material that will pass through your bloodstream and be absorbed into your bones. It will be absorbed at the site where there is unusual activity, such as inflammation. The scanner will detect it and show your surgeon the “hot spots” so he can determine where the problem is.
- Discogram or discography – This procedure confirms or rejects the possibility that the disc is the source of your pain. A small amount of safe contrast fluid is injected into one of the discs. If there is a problem such as a hernia, the dye will leak from the disc. Your surgeon will see this on the x-ray, which will help him understand where something is wrong
- Myelogram – To be able to tell if there is a disorder in your spinal canal or in your spinal cord due to a pinched nerve and this is causing your pain, you will need to have a myelogram. For this test, you must be injected with a special harmless colored fluid at the area around the spinal cord and nerves. Before that, however, the place must be anesthetized. You will then have an X-ray or CT scan. The image will give a detailed anatomical picture of your spine, especially your bones, which will help your surgeon identify any abnormalities.
To prevent the development and aggravation of a disease associated with your spine, it is recommended that you be examined before your pain becomes unbearable or complicates your condition.