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TESTS FOR ACUTE BACK PAIN
When is further testing needed? When the pain does not improve and activity or work becomes more limited, or when muscle weakness is found in a leg or foot, or when the bladder or bowel habits are affected. A diagnosis may be made after discussion and examination, and is usually confirmed by results of one or several tests.
If your acute back pain has not improved after the standard treatment, further testing is also warranted.
These are the tests most commonly used for further evaluation:
? X-Rays. X-rays of the lower (lumbar) spine are an easy way to examine the bones in this area, but in most cases of acute back pain, these x-rays do not give the problem’s answer. X-rays can detect cancer, fractures in the spine, arthritis, and some infections. X-rays are not able to detect a ruptured disc.
X-rays may not be necessary unless the pain persists. Refraining from using x-rays too quickly limits your exposure to radiation and your expense.
? Computed Tomographic Scan. A computed tomographic (CT) scan of the lower (lumbar) spine can detect the rupture or herniation of a disc in 75 percent or more of cases. Like most tests, CT is not perfect. This test may occasionally suggest an abnormality when the disc is actually normal. CT is better than x-ray for detecting other problems in the spine, such as infection, fracture, and cancer.
A CT scan has an acceptable level of radiation exposure.
? Magnetic Resonance Imaging. Magnetic resonance imaging (MRI) is considered by most experts to be as good as or better than CT scan for detecting ruptured discs in the lower (lumbar) spine. It shows the ruptured disc accurately in 90 percent or more of cases and is not painful.
MRI is more expensive then CT scan but does not have radiation exposure. Some problems may be found more easily using MRI, but, to diagnose some patients, CT or a combination of tests may be needed.
MRI and CT scan can be done without admission to the hospital. Both tests can be done without injections of medications or dye, and both have minimal risk.
? Myelogram. Myelogram is a test that requires an injection of dye to show the rupture of a disc or other problems in the lumbar spine. It detects the rupture in over 90 percent of cases. Because it requires an injection, the myelogram has more discomfort and a higher possibility of unwanted side effects such as headache. Some experts now recommend MRI of the lumbar spine, with a myelogram performed only if the MRI does not give a clear answer.
CT scan may be combined with myelogram to improve the accuracy of diagnosis.
? Bone Scan. A bone scan is a test that can detect abnormal areas in all bones of the body, including the spine. This test is used in some cases when there is suspicion of infection, cancer, or fracture. It does not replace the above tests but may add information by eliminating these other serious problems.
Other causes of pain in the back may be discovered by your doctor, often with the help of a consulting specialist such as an orthopedic surgeon or neurosurgeon. Each person is different and may require a different combination of tests.
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