Diagnosing Back Pain

One of the videos on the updated educational resource section of Indiana Spine Group’s web site is about back pain. In this video, minimally interventional spine  specialist John Arbuckle, MD, defines spinal/back pain, and he provides an overview of diagnosing back pain and treatment. To view this spine wellness education video on spinal / back pain, click here. 

One test for diagnosing back pain for patients suffering from chronic lower back pain (lumbar spine) is a discogram. The objective of this diagnostic test is to determine if a suspected disc, or discs, is/are a potential source to a patient’s lower back pain.

To perform this spinal diagnostic test, the patient is given medicine intravenously for mild sedation. Using an X-ray machine called a fluoroscope, a needle is placed into the spinal disc(s) that are suspected to be causing low back pain, as well as an unsuspecting adjacent disc to serve as a ‘control.’ A dye is then injected into the disc(s) of which creates pressure in the disc and outlines its internal structure. 

In a normal disc, the patient typically experiences a slight pressure sensation in the back, and the X-ray image of the disc typically appears intact. If a disc is a source to a patient’s low back pain, the patient should experience pain similar in character and location of their usual low back pain. The X-ray image of a painful characteristically demonstrates a tear extending from the inner ‘nucleus’ through the outer ‘anulus.’

One of the tools that we use to diagnose back pain is selective nerve injections (SNI).  Imaging studies, such as MRI’s, do not always show which nerve is causing the back pain, and selective nerve injections are effective in helping us to isolate the source of the patient’s pain. 

With diagnostic selective nerve injection, just enough medication is used to numb one or two spinal nerves.  This medication is then injected, and this helps us to determine if the nerve root is causing the pain. 

Additionally, a study that I co-investigated concluded that selective nerve injections were also a valuable tool for patients requiring surgery for radiculopathy; a lumbar cervical decompression.  This study determined that selective nerve injections can accurately determine the presence of a specific painful nerve root in cases where physical exam and/or MRI findings are equivocal.  This helps spine surgeons determine their surgical treatment and oftentimes limiting its scope.  Here is a link to the research study. 

People with back problems – may have more than just back pain.  Sometimes, if you suffer from leg pain – this can be related to your spine.  If a person has ongoing leg pain that is persistent and increases as you lift your knee to your chest or bend over – it could be related to your back.  One back problem – that causes a shooting pain down your leg referred to as “sciatica” is lumbar radiculopathy.