In most cases, a specialist is able to make the diagnosis after physical examination and medical history, and imaging tests are done only to confirm the diagnosis and provide additional information.
Low back pain is a common problem, especially in developed countries. These pains can have several causes, so it is recommended to consult a specialist to determine the exact cause of the condition that causes back pain.
After low back pain, it is advisable to go to the family doctor / general practitioner. He will perform a physical examination and discuss his symptoms and medical history with his patient, and then determine which doctor will refer the patient to.
The doctor who can put a diagnosis for a disease that has symptoms of low back pain can be: orthopedist, rheumatologist, neurologist or even internist, if it is suspected that the pain may be related to a disease of an organ and radiates to the lumbar area elsewhere (for example , kidney disease).
A complete medical history and physical examination can usually identify any serious condition that may be causing the pain. During the exam, the doctor will ask about the onset, location, and severity of the pain; duration of symptoms and any limitations in movement; history of previous episodes or any health conditions that may be related to pain.
Along with a detailed examination of the back, neurological tests are performed to determine the cause of the pain and the appropriate treatment. The cause of chronic lower back pain is often difficult to determine even after a thorough examination.
Imaging tests are not justified in most cases. Under certain circumstances, imaging may be recommended to rule out specific causes of pain, including tumors and spinal stenosis.
- Magnetic resonance imaging (MRI)
- Ultrasound imaging
- Bone scans
- Blood tests
- Computed tomography (CT)
Magnetic resonance imaging (MRI)
It uses a magnetic force instead of radiation to create a computer generated image. Unlike X-rays, which show only bone structures, MRI scans also produce images of soft tissues such as muscles, ligaments, tendons, and blood vessels.
An MRI may be recommended if a problem such as infection, tumor, inflammation, herniated disc, rupture, or pressure on a nerve is suspected. MRI is a non-invasive way to identify a condition that requires prompt surgical treatment. However, in most cases, an MRI scan is not required during the early stages of back pain.
They are also called ultrasound scanning or sonography, uses high frequency sound waves to obtain images inside the body. Sound wave echoes are recorded and displayed as real-time visual images. Ultrasound imaging can show tears in ligaments, muscles, tendons and other soft tissue masses in the back.
They are used to detect and monitor infections, fractures or disorders in the bone. A small amount of radioactive material is injected into the blood and will collect in the bones, especially in areas with an abnormality. The images generated by the scanner can be used to identify certain areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.
Those are not commonly used to diagnose the cause of back pain. However, in some cases, they may be performed to look for indications of inflammation, infection, or the presence of arthritis. Potential tests include erythrocyte sedimentation rate and C-reactive protein.
It is often the first imaging technique used to look for broken bones or injured vertebrae. X-rays show bone structure and any vertebral misalignment or fractures. Soft tissues, such as muscles, ligaments, or clogged discs, are not visible in conventional X-rays.
It can be used when other diagnostic procedures fail to identify the cause of the pain. This procedure involves injecting a contrast dye into a spinal disc that is thought to cause low back pain. Fluid pressure on the disc will reproduce the person’s symptoms if that disc is the cause.
The dye will show damaged areas on CT scans performed after injection. Discography can provide useful information in cases where people are considering lumbar surgery or where their pain has not responded to conventional treatments.
Computed tomography (CT)
It is used to see structures of the spine that cannot be seen on an X-ray, such as a ruptured disc, spinal stenosis, or tumors. Using a computer, CT scanning creates a three-dimensional image from a series of two-dimensional images.
They increase the diagnosis of X-ray and CT images. In this procedure, a contrast dye is injected into the spinal canal, making it possible for a compression of the spinal cord and nerves, caused by herniated discs or fractures, to be seen on an X-ray or CT scan.