Imaging Studies

There are a variety of ways to get a good image of what is going on in the spine. Some are not very expensive and some cost more and are considered the gold standard. Here are a few commonly used technologies:

Radiography (xrays):

This is the quickest, cheapest, easiest study to get, and it can be done in the office within a few minutes. I usually obtain at least anteroposterior (AP) and lateral views. The disc is best visualized on lateral views. These images show the disc height, bone spurs, and any spondylolisthesis (slip of one vertebral bone on another). If spondylolisthesis is detected, I will add flexion and extension views to see if the slip increases or decreases when bending at the waist. I will obtain oblique images usually only if I’m looking for spondylolysis (pars fracture).

CT scanning:

This is often the best image to look specifically at the bone structure. Again, disc height can be seen, along with bone spurs and sclerosis. Some disc bulges and herniations can be seen, but not with the detail of MRI. CT scan can be combined with myelography (dye injected into spinal column) to help detect compression of the nerve roots.

MRI (magnetic resonance imaging):

This is currently the gold standard for detecting disc pathology. A magnetic field is used to obtain multiplanar images with superb soft tissue contrast. The resolution is excellent, and MRI is much more sensitive than CT scanning for evaluating the discs. Disc hydration can be evaluated. Disc height can be evaluated. Bulging and herniations can be seen superbly, as well as high intensity zones (HIZ). These are also referred to as annular tears or fissures (tears in the tough cartilage lining of the disc). The false-negative of MRI is extremely low; however, the false-positive can be significant (i.e, there are millions of people with degeneration on MRI without pain).

by Nathan S. Walters, MD

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