What You Need To Know
It is not unusual for patients to request a spine scan. It also happens rather frequently that a scan is not required. For the majority of straightforward cases of back pain, a thorough history and examination are significantly more valuable than a scan.
A highly detailed image of the spine’s structure can be obtained by magnetic resonance imaging (MRI) scans. It doesn’t explain to the physician why the spine hurts. We are unable to determine the cause of back discomfort in 85% of patients. In order to recover more quickly, it is frequently more beneficial to focus on returning to regular activities and taking quality pain relievers.
When it comes to severe spinal conditions like cancer, infections, or nerve compression, scans are incredibly beneficial. Clear criteria regarding “Red flags” or significant symptoms are helpful in determining whether a scan is necessary. Among the “red flags” are a history of cancer surgery in the past, weight loss, or limb weakness.
For spine surgeons, “mixed messages” is a prevalent issue. When scan results are described in a “dramatic” manner, patients may become highly alarmed. A disc that has lost water content appears darker than others. This could be typical. Degenerative discs is one description that could raise concerns; yet, if it were stated as “a bit like getting grey hair,” that description would be less alarming. A disc “prolapse” is not the same as a normal disc “bulge.” While a disc prolapse might occasionally be completely painless, it can also occasionally result in symptoms. A physician who treats spinal diseases should be able to interpret your scan in a clinical context and advise you on whether a scan is necessary. They ought to be able to walk you through the images and give you an explanation.
The Detail
Since the early 1980s, magnetic resonance imaging, or MRI, has become a relatively novel diagnostic method.
Since the MRI scan employs magnetic and radio waves instead of X-rays or other harmful radiation, there is no radiation exposure during the procedure.
There are no known risks or adverse effects associated with MRI scans. You won’t feel any pain during the exam. The process can be repeated without issue because radiation is not used. The first 12 weeks of pregnancy carry a tiny potential risk to the foetus, hence pregnant women are not subjected to scans at this time.
Certain individuals experience claustrophobia during the scan procedure because they must lie within a big cylinder. Patients should discuss their fears with their doctor in advance, since he or she may prescribe medicine to help them relax.
Additionally, there is a loud noise produced by the machine while it operates, which may not be pleasant.
It can provide an incredibly clear image of the spine’s structure.
Here you can see a significant disc prolapse at the Lumbar 4/ 5 disc
Since the early 1980s, magnetic resonance imaging, or MRI, has become a relatively novel diagnostic method.
Since the MRI scan employs magnetic and radio waves instead of X-rays or other harmful radiation, there is no radiation exposure during the procedure.
There are no known risks or adverse effects associated with MRI scans. You won’t feel any pain during the exam. The process can be repeated without issue because radiation is not used. The first 12 weeks of pregnancy carry a tiny potential risk to the foetus, hence pregnant women are not subjected to scans at this time.
Certain individuals experience claustrophobia during the scan procedure because they must lie within a big cylinder. Patients should discuss their fears with their doctor in advance, since he or she may prescribe medicine to help them relax.
Additionally, there is a loud noise produced by the machine while it operates, which may not be pleasant.
It can provide an incredibly clear image of the spine’s structure.
The Good News
When a scan is used to look for major spinal illnesses like tumors or infections, it is highly sensitive to these conditions and will almost always find them if they are present. This makes it an extremely helpful tool for the evaluation and diagnosis of infections and cancer.
An examination by a physician will nearly always reveal clinical symptoms, such as altered reflexes, altered muscular weakness, or altered sensory areas, when pressure is applied to the spinal cord or spinal nerve. For instance, if the straight leg lift test results are fewer than sixty degrees, it may indicate that a disc protrusion is irritating a nerve.
Spinal stenosis in elderly adults can cause the spinal canal to narrow and make walking difficult. An MRI scan is helpful in this case for both diagnosis and treatment planning.
The scan serves as a “map” that directs treatment if the patient’s symptoms are severe enough to warrant consideration of operations or procedures.
Should the symptoms be mild or improving on their own, a scan might not change the course of treatment.
The Bits You Might Not Have Heard About
The scan does not identify the source of back pain.
For the treatment of back pain as opposed to nerve pain, the scan is only performed on patients who are seriously considering surgery.
Surgery for back pain, such as disc replacements or fusions, or other major procedures, is only taken into consideration following the exhaustion of conservative measures. Few patients—less than 3%, according to some studies—are candidates for surgery if they suffer from back discomfort. Painkillers and physical activity are safer forms of treatment that frequently alleviate symptoms. Intense spine exercise and education programs have been demonstrated in recent research to be less risky and equally effective as spine fusion surgery.
Because they come and go, intermittent and fluctuating aches do not necessarily signify a significant spinal condition. For sufferers, back pain can be quite stressful and disturbing. We are unable to determine the source of the pain in 85% of cases, and a scan is ineffective in this regard.
When it comes to identifying severe spinal disease and determining if a scan is necessary, spine specialists are very skilled.
Surgical scans have a “sell by” date, and the ailment being treated must be current for surgical treatments. For sciatica surgery, for instance, the scan needs to be very recent.
MRI scans are extremely sensitive diagnostics that frequently reveal information unrelated to the current issue. “Treat the man (or woman) and not the scan” is our guiding principle.
Simple or 'Non Specific' Low Back Pain
According to the majority of national and international guidelines, an MRI scan is not necessary for these disorders.
The majority of back pain (around 85%) is non-specific, meaning its cause is unknown. The muscles, joints, discs, and ligaments in the spine could be the source of the pain. A scan is useless in this case and cannot identify the cause of the pain. Changes resulting from the spinal column’s natural aging process may be shown on scans (similar to your hair growing grey and thinner as you get older). This is a common shift on scans in middle age, and it does not necessarily mean a medical condition. If we misinterpret the scan results and believe your symptoms are a typical age-related change, we may end up treating you improperly.
It’s actually far more beneficial for us to listen to you, take a thorough clinical history, and then examine you. It’s really useful to know “the agenda,” your expectations, and what you hope to get out of our visit. Helping you helps us.
Why You Might Wait For A Scan
Ensuring that the appropriate patients receive the right treatment is imperative. Patients with cancer, infections, or significant diseases are given precedence. Patients in this category typically have short wait times.
In a surgical spine clinic, nerve discomfort and spinal cord compression are conditions that are prioritized and may occasionally necessitate surgery.
Because MRI scans are extremely sensitive, sometimes the results we find are unclear in their interpretation. An analysis of scans done on people who had no back discomfort at all revealed anomalies in 87% of the cases. One prevalent result is “disc degeneration,” which is found in 20% of individuals in their twenties, 40% in their 40s, and 80% in their 60s. It is not cause for concern; it is similar to growing gray hair.
These are the reasons MRIs are rarely performed and are not considered a high clinical priority when it comes to treating basic back pain.
What To Expect If You're Sent For A Scan
A survey regarding the safe usage of scans is filled out.
A scan is not recommended if you have a pacemaker or some metallic implants because they can lead to serious consequences.
Although the scan is completely painless, earplugs are provided because it is fairly noisy.
There are “open” scanners available if you feel claustrophobic, or you can be given a light sedative, but make sure you inspect the equipment and the room first.
Picture quality is greater when scanning if you can remain motionless.