Spinal Imaging: X-ray vs. MRI
Plain film x-rays are excellent at providing information about overall alignment and spacing of the of the separate spinal bones. Frequently used in this setting of acute trauma looking for fractures and/or dislocations of the spine to some lesser extent they also can be valuable in diagnosing degenerative problems . loss of disk spacing as low as well as sclerosis of facet joints together are xray findings that lead to the impression of a degenerative motion segment.
The MRI (magnetic resonance imaging) is a technique that produces an image of bones, discs, and nerves.
Indications for this test are the presence of symptoms and physical signs consistent with neural compression the source of which can be seen on MRI is frequently additionally they are used in this setting to evaluate the spinal column. They are most effective and useful in the setting of evaluating the acute onset of neurological symptoms such as sciatica leg or arm pain. It is not, in my opinion, a universally useful test used in evaluating chronic backache. Backaches of less than 6 weeks duration are not necessary to obtain an MRI.
The most important diagnostic tool in the evaluation of neck and back discomfort in my opinion is a clinical evaluation to include history and a physical examination.
Another diagnostic test are bone scans. These are ordered when all other imaging tests are negative. This test can look for areas of bone inflammation that explain pain symptoms of pain such as hidden fractures or facet arthritis.
The 4th test would be plain x-rays with dynamic positioning. Using views with flexion and extension, this study identifies abnormal motion within the spinal column. This is especially important after trauma.
In my clinical practice when I see a patient we do a detailed pain history and physical exam. Frequently a diagnosis for your pain generator can be determined with these 2 tools alone. When the diagnosis is difficult to confirm or other diagnoses need to be ruled out I will then turn to additional spinal imaging. Surprisingly, the first test I use are x-rays and not MRI’s. When I’m looking for degenerative signs, alignment abnormalities or a history of trauma (or any acute onset of pain) then an MRI is useful.
This may be surprising as many patients will bring an MRI study to our first appointment. We will use this as a tool if available but there may be better diagnostic tools and methods than the detailed images these provide.
If your in pain and need a guide or clarifying opinion call my office for an initial evaluation. 503-675-1137