Every day, I get letters from patients who say that they were diagnosed with a herniated disc and possibly even a pinched nerve by a doctor or chiropractor who took x-rays. Normal spinal degeneration or a congenital, genetic or developmental disc abnormality might all look identical on x-ray imaging studies.
The only thing which will be decisively noticed is a lack of typical disc space, with the vertebral bones closer together than would normally occur. When used to focus on disc abnormalities, x-rays are a complete waste of time, money and offer an unnecessary exposure to dangerous radiation.
The adult spine is made up of 24 bones called vertebrae. Some vertebrae are cushioned by soft disks made of a jellylike substance.
But if a disk between two vertebrae starts slipping out of place, it can irritate the surrounding nerves and cause extreme pain. The pain may spread from your back to your buttocks, thighs, and even to your calves.
Continued Discomfort from a herniated disk usually gets worse when you're being active and lessens when you're resting. Even coughing, sneezing, and sitting can worsen your symptoms because they put pressure on pinched nerves.
They’ll likely do a physical exam to find the source of your pain. Your doctor will check your back for sore or painful spots.
If your doctor wants to rule out other sources of your pain, or pinpoint specific nerves that are aggravated, they may do further test, including: A CT (or CAT) scan takes several X-rays from different angles and combines them to create images of your spinal cord and the structures surrounding it.
An MRI uses radio waves, a magnetic field, and a computer to create detailed 3D images of the spinal cord and surrounding areas. MRI images can locate the position of the herniated disk, look inside it, and also determine which nerves are affected.
The EGG test uses a device to detect the tiny amount of electricity muscle cells make when they're stimulated by nerves connected to them. A needle electrode put into a muscle records its electrical activity and looks for anything that isn’t as it should be.
Nerve conduction studies (NCS) are often done at the same time as the EGG. The time it takes for the electrical impulses to travel between electrodes lets your doctor know whether there is nerve damage.
North American Spine Society: “Specialized Nerve Tests: EGG, CV and STEP.” Radiating pain, numbness, tingling, or weakness in the legs or arms may indicate that the disc is pressing on a nearby nerve.
Most of the time, pain associated with a herniated disc goes away on its own over a period of weeks or months and does not cause permanent damage to the spine or nerves. A herniated disc that pinches a nerve in the lumbar spine can result in pain in the lower back that may radiate to the legs and feet.
Your doctor may recommend diagnostic tests to get more information on the condition of the nerves, vertebrae, and discs. Doctors ask you about your medical and family history to determine whether a herniated disc is the cause of your symptoms.
A doctor may also expose areas of your skin to stimuli such as warm and cool temperatures to assess whether sensation is affected. Your doctor may ask you to use specific muscle groups in moving parts of your body to assess strengths and weaknesses.
X-rayscanshow a change in the height of the disc space or a shift in a vertebra’s position but cannot show a herniation itself. An MRI scan may be used to get a closer view of the vertebrae, discs, and surrounding soft tissues, including the spinal cord and any affected nerves.
An MRI machine uses a magnetic field and radio waves to create two- and three-dimensional images of parts of your body. If you feel pain radiating into your arms or legs, or weakness, tingling, or numbness, an electromyography (EGG) can reveal whether nerves are being pinched as a result of a herniated disc.
This test helps doctors to determine if pain or weakness originates in the muscles or nerves. During an EGG, a doctor inserts small, thin needles, called electrodes, through the skin and into muscles that correspond to specific nerves.
If unable to have an MRI (due to a pacemaker) a pyelogram and post-myelo gram CT is useful. Special X-rays :Routine spine x-ray will not show need MRI or some time ct scan of spine is needed.
Only at later stage:X=ray is not a good screening tool for spinal tumor, as visualization of a radiolucent defect on x-rays requires a 50% destruction of the vertebral Beau ... Read More. It may show disc space narrowing which is suggestive of disk disease.
25 years experience Physical Medicine and Rehabilitation Not X-rays MRI rec'd:MRIs for the lumbar spine are not usually urgent, thus it would be a good idea for you to see your primary care MD or a spine specialist who can order ... Read More.
Different tests:Plain X-rays of the spine only show bones structure, an MRI is needed if you are looking for soft tissue pathology like a herniated disk. During the physical exam, your doctor will check your back for tenderness.
You might be asked to lie flat and move your legs into various positions to help determine the cause of your pain. In most cases of herniated disk, a physical exam and a medical history are all that's needed for a diagnosis.
If your doctor suspects another condition or needs to see which nerves are affected, he or she may order one or more of the following tests. Plain X-rays don't detect herniated disks, but they can rule out other causes of back pain, such as an infection, tumor, spinal alignment issues or a broken bone.
A CT scanner takes a series of X-rays from different directions and then combines them to create cross-sectional images of your spinal column and the surrounding structures. Radio waves and a strong magnetic field are used to create images of your body's internal structures.
This test can be used to confirm the location of the herniated disk and to see which nerves are affected. This test can show pressure on your spinal cord or nerves due to multiple herniated disks or other conditions.
During an EGG, your doctor inserts a needle electrode through your skin into various muscles. The test evaluates the electrical activity of your muscles when they contract and when they're at rest.
If your pain doesn't improve with oral medications, your doctor might recommend a corticosteroid that can be injected into the area around the spinal nerves. Because of the side effects of opioids and the potential for addiction, many doctors hesitate to prescribe them for disk herniation.
If other medication doesn't relieve your pain, your doctor might consider short-term use of opioids, such as codeine or an oxycodone-acetaminophen combination (Percent, Roxie). Sedation, nausea, confusion and constipation are possible side effects from these drugs.
Physical therapists can show you position and exercises designed to minimize the pain of a herniated disk. Discectomy is the surgical removal of the damaged portion of a herniated disk in your spine.
This can irritate or compress nearby nerves and cause pain, numbness or weakness. Few people with herniated disks eventually need surgery.
Your doctor might suggest surgery if conservative treatments fail to improve your symptoms after six weeks, especially if you continue to have: In nearly all cases, surgeons can remove just the protruding portion of the disk.
In these cases, the vertebrae may need to be fused with a bone graft. To allow the process of bone fusion, which takes months, metal hardware is placed in the spine to provide spinal stability.
Rarely, your surgeon might suggest the implantation of an artificial disk. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.
Initially, cold packs can be used to relieve pain and inflammation. After a few days, you might switch to gentle heat to give relief and comfort.
Make sure your movements are slow and controlled, especially bending forward and lifting. Some alternative and complementary medicine treatments might help ease chronic back pain.
Spinal manipulation has been found to be moderately effective for low back pain that has lasted for at least a month. Rarely, chiropractic treatment of the neck can cause certain types of strokes.
Although results are usually modest, acupuncture appears to ease chronic back and neck pain. This hands-on therapy can provide short-term relief to people dealing with chronic low back pain.