Magnetic Resonance Imaging (MRI) uses magnets and radiowaves to construct slice by slice computer images of the inside of a patients body. The images show all the relevant tissues including bone, nerve, disc, ligament etc. On average these scans take half an hour to perform and involve lying very still inside a tunnel, although newer versions use open or even seated scanners.
Open MRI Scan
Some patients find lying still in the tunnel of standard MRI scans very claustrophobic. Open MRI scan machines do not feature a tunnel but an open bed similar to an x-ray machine.
Seated / Upright MRI Scan
Seated MRI scans are another version of open MRI scans but rather than lying down, the scans are performed with the patient sitting or standing. This may reveal problems such as disc bulging that is not evident when the spine is not subject to the loading of body weight (such as with standard MRI scans performed with the patient lying down).
3T MRI scan
The latest breed of MRI scans feature “3T” scanning, which gives a higher image resolution than the older 1.5T scanners.
X-rays are relatively quick and cheap to perform, however they do involve exposing the patient to an amount of x-ray radiation and they only really show bone tissue. Their main purpose is to highlight problems such as bone fractures, bone infections, bone spikes (osteophytes) and bone tumours. Normal age related wear and tear commonly shows up on x-ray and is often unrelated to symptoms. Conversely a normal x-ray excludes very little, x-rays do not show other structures of the spine that may be injured such as the discs, ligaments and nerves.
Dynamic (Functional) X-ray
Rather than taking an x-ray of the spine lying down, dynamic functional x-rays are performed with the patient sitting, standing, bending forward and / or bending backwards. This can give valuable information about foraminal volumes, scoliosis, facet joint hypertrophy and osteophytes, prior surgery, gas in the disc, degree of anterior olisthesis, retrolisthesis, spondylolytic spondylolisthesis, pelvic tilt and which segments of the spine are over or under working when moving. This information may not be observable on standard (lying down) x-ray or MRI scans.
The main use of ultrasound scanning for back problems is to assess the recruitment of specific deep abdominal (core) muscles which have a supportive role for the spine. Ultrasound scans can also be used assess damage in some muscles, ligaments and tendons that lie relatively near the surface, but this particular use is mostly reserved for problems in peripheral joints such as the shoulder.
Single Photon Computed Tomography (SPECT) uses a radioactive (tracer) chemical which is injected into the blood stream and attaches to areas of unusual metabolic activity and blood flow, so called “hot spots” which often indicate sites of pain generation and which may not have previously been identified on other diagnostic imaging such as MRI or X-ray. By combining a SPECT scan with with a (low field – low radiation) CT scan better imaging of a pain generating area can be achieved so that exact structures such as ligament, joint capsule or disc can be identified as the source of pain. This information can then lead to a more precise therapeutic intervention.
It is sometimes necessary to refer patients for other tests such as nerve conduction tests or blood tests to full differentiate between certain conditions. At Spine Plus we have access to the full range of such tests so that we can get to the bottom of your problem.