When you seek medical help after sustaining a neck or back injury in an accident, the physician first takes a complete history. This includes the circumstances of your accident, your general medical condition and your individual lifestyle, including your symptoms, the location and severity of the pain, what home treatments you have used, what kind of work you do, etc. A complete physical exam follows. Afterwards, if the doctor cannot accurately identify a specific type of back or neck injury, one of more of the following diagnostic tests may be ordered:
- Computerized Axial Tomographic Scan (CT or CAT scan)
- Magnetic Resonance Imaging (MRI)
- Electromyogram (EMG)
- Bone Scan
X-rays are probably one of the best known diagnostic tests. X-rays are generally indicated only for patients who have had pain for more than one month or who have had a significant injury. Patients over the age of 60 should have x-rays at the onset of pain if there has been no injury.
During an X-ray, low doses of invisible electromagnetic energy with short wavelengths pass through the body and cast a “shadow” photograph onto a film or screen. Since bones are dense, they absorb X-rays well and show up as white on the film, while the tissues show up darker.
One of the reasons X-rays are beneficial is that they can be performed quickly. Since they highlight the bones, X-rays can be helpful in uncovering an injury in a back bone, a tumor in the spine, or a spinal deformity, but they are not effective in finding injuries to the soft tissues. Still X-rays often help the physician determine what other tests should be given.
During an X-ray test, you lie on a table, with the adjustable X-ray machine above you. You won’t feel anything when the rays pass through your body. The technician will ask you to remain still while the X ray is being taken so that the image will not be blurred.
The exposure time during an X-ray is just a fraction of a second, and with modern equipment, the radiation dose is very low. However, x-rays are usually not performed if there is the possibility of pregnancy, and a lead shield may be used to cover the patient’s reproductive organs from the X-ray beam.
Computerized Axial Tomographic Scan (CT or CAT scan)
An important diagnostic tool, a CT scan combines X-rays with computer technology, offering more information than plain X-rays. CT scans are fast, safe and painless and may be combined with other tests, such as myelograms and discograms (see page t/k), to achieve the most accurate diagnosis possible.
During a CT scan, an X-ray beam passes through the body at various angles. The machine uses a computer to detect the degree to which the tissues of the body are absorbing the x-rays and then reconstructs an image. One of the benefits of the CT scan is that gives a cross sectional look to the spine, so the physician can essentially see inside the body to diagnose the condition. The CT scan is helpful for detecting ruptured discs, spinal stenosis, tumors and infections of the vertebra.
While receiving a CT scan, you’ll be lying on a table that moves you slowly through the CT scanner–a large donut-shaped machine. The machine passes a great number of thin X-ray beams, each of a low dosage and lasting only a fraction of a second, through your body at different angles as the scanner rotates around you. The test takes anywhere from 15 minutes to an hour, and you can’t eat solid food for three hours prior to the exam.
Although the CT scan is harmless, you are subjected to X-rays. So, again, if there is the possibility of pregnancy, inform your physician.
Magnetic Resonance Imaging (MRI)
One of the most advanced diagnostic imaging methods available today, the MRI provides a great deal of information about the human body and is often used to evaluate the spine. Unlike plain X-rays, this noninvasive test not only shows the physician the bones, but also provides excellent details of the soft tissues. However, the MRI is not always the first test given since it is more expensive and generally takes longer than the X-rays or CT scans.
Instead of radiation, a MRI uses magnetic waves to take pictures of the spine. A magnet excites the hydrogen atoms in the body, which give off electromagnetic waves that are recorded by a computer. The computer then analyzes the results to reconstruct an image of the spine.
The MRI scanner is a large tube with a table passing through it. Some people worry about feeling closed in, however, the tube always remains open on both ends. You won’t feel any pain, but you will hear some loud noises during the exam. Depending on how many pictures are needed, the exam can take anywhere from 20 minutes to 90 minutes.
It is very important that you notify your physician if you have any metal in your body which cannot be removed, such as a pacemaker, aneurysm clips or a prosthesis. You may not be able to have an MRI if you have such metal in your body. Leave your jewelry at home, and remove all metallic objects such as hearing aids and dentures before entering the scanning room.
A myelogram is more invasive than a MRI but may be necessary sometimes to better diagnose the patient’s condition. A CT scan is often performed at the same time as the myelogram in order to gather even more information.
During a myelogram, special dye that shows up on X-rays is placed into the spinal sac. If there is any decrease or blockage in the flow of the cerebral spinal fluid around your spinal column, it may mean there is pressure on the nerves of the spine, possibly from a herniated disc or bony spur, or, less often, a tumor.
While you lie on a X-ray table, you are given a local anesthetic to numb the area. A needle is placed into the area near your spine, dye is injected and then the X-rays are taken. The test will take about an hour to complete. Afterwards, you may be taken for a CT scan, which can offer some additional information that the myelogram may not find. For example, if a piece of disc has broken off and is pressing on a nerve somewhere other than its root, a CT-scan may detect it while the myelogram may not.
You won’t be able to eat solid foods after midnight the night before your test, but please drink plenty of fluids such as water, tea and juice in order to be well hydrated. Just stop drinking fluids three hours beforehand. Ask your physician about any medications you are taking. After your myelogram, you will need plenty of rest, and you cannot drive yourself home.
Your radiologist will discuss the risks of the myelogram, which are very small but include itching around the puncture site, infection and allergic reactions. You may develop a headache either several hours or several days after the test. This is usually caused by a change in the pressure of the cerebral spinal fluid and should be cured with rest and plenty of fluids.
The discogram is similar to the myelogram in that special dye is injected and X-rays are taken. It is also often accompanied by a CT scan. However, the dye is injected into the spine’s discs rather than the spinal sac. While discs don’t show up on ordinary X-rays, the X-rays of the dye may be able to show if a disc has ruptured since any leakage of dye will be revealed. Also, any sensation of pain from the injection may indicate that a particular disc is the source of the patient’s pain.
During the test, you will be hooked up to an IV to sedate you if necessary and protect against any allergic reaction. While you’re lying face down on the table, needles are injected into the selected discs, iodine dye is injected and X-ray pictures are taken. The procedure takes about 20 minutes and may be uncomfortable. Then you may be sent for a CT scan to give your physician even more information.
Don’t eat after midnight the day of your exam, and ask your physician if you should take your regular medications. The dye will be removed from the body through the flow of urine a few hours after the procedure. You will not be able to drive home because of the sedatives. You will need to rest at least overnight after the procedure.
The EMG studies the condition of the nerve roots leaving the spine by examining the electrical activity in the muscles which these nerve roots control. For example, if you are feeling lower back pain, your leg muscles may be tested to see if there is a problem with the nerves that travel to your lower extremities.
During an EMG, tiny electrode needles are inserted into the muscles being tested. The electrical activity of the muscles is examined during both contraction and rest, and the electrical activity in the muscle is amplified, displayed and recorded for analysis. If the muscle is not functioning normally, it may mean that a nerve is being irritated or pinched–perhaps a sign of a herniated disc or spinal stenosis.
The test takes anywhere from 30 minutes to an hour, depending on the number of muscles being tested. The EMG is safe, although the needles may cause bruising.
A bone scan is a type of radionuclide imaging that can help a physician locate the affected area of the spine. It can help evaluate spinal tumors, infection or occult fractures more accurately than plain X-rays.
During a bone scan, a radioactive chemical is injected into the bloodstream. This chemical adheres to parts of the bone which are undergoing rapid changes. After a gamma camera scans the area, these parts show up as dark areas on the film. Once the physician has identified the affected area of the spine, other tests may be given to look at the area more closely.
The bone scan is safe since the levels of radiation in the chemical are very low–even lower than the levels one is exposed to during plain X-rays.
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