Lower Back Pain X Ray
What Is a Spinal X-Ray? Medically Reviewed by on March 02, 2023 A spinal X-ray is a procedure that uses radiation to make detailed pictures of the bones of your spine. It can help your doctor find out what’s causing your back or neck pain. A technician uses a machine that sends X-ray beams through your body.
It records a black-and-white image on a special film or computer. Bones, and other parts of your body that are thick or dense, show up white in the picture. Softer tissue, like fat or muscle, appears in shades of gray. Your doctor can take separate X-rays that focus on the different parts of the spine, which is made up of 33 small bones called vertebrae.
Your spine is split into sections:
(seven vertebrae in the neck)Thoracic spine (12 vertebrae in the chest or trunk area)Lumbar spine (five vertebrae in the lower back)Sacral area (five small, fused vertebrae in the base of the spine) (four coccygeal vertebrae fuse to form one bone called the coccyx or tailbone)
A spinal X-ray can help your doctor figure out if you have:
Broken bonesSpinal disk problemsTumorsOsteoporosis (thinning of the bones)Abnormal curves of the spineAn infectionSpinal problems you were born with
X-rays are useful in pinpointing broken bones or skeletal defects. They can sometimes locate problems in connective tissue. X-rays and imaging studies are generally used to confirm your symptoms and exam results to identify the source of pain. Scans are also used in cases of direct trauma to the back, back pain with fever, or weakness or numbness in the limbs.
While don’t show as much detail as other imaging tests, they are often the tests doctors use at first to help them decide on your next steps. Computed tomography (a CT scan) combines X-rays with computer technology to create a picture that shows a cross-section, or slice, of the bone. For the most detailed pictures of the spine and all its parts, doctors often suggest (MRI).
It uses powerful magnets, radio waves, and a computer – not radiation. For most people, X-rays are safe. Some worry that the radiation can cause changes in cells that may lead to, But the amount used in spinal X-rays is small, so the chance is low. You may want to keep track of previous X-rays to let your doctor know about it.
There may be some risks from the number of X-rays over a long period of time. If you have concerns about it, talk to your doctor. But unborn babies are more sensitive to radiation. Tell your doctor if you’re or think you might be. They may suggest another type of imaging test. Before your spinal X-ray, besides telling your doctor that you are or might be pregnant, let them know if you have an or if you’ve had any other types of X-rays, like a barium X-ray, in recent months.
You may need to remove your clothes and wear a gown during the test. Also, anything that’s made of metal may show up on an X-ray, so remove things like these beforehand:
You’ll lie down on a special exam table. An X-ray machine will be hanging above you. A drawer under the table holds the X-ray film or digital recording plate. A specially trained technician will position you on the table so that the section of your spine getting X-rayed is between the machine and the drawer with the film.
- They may cover the other parts of your body with a special apron made of lead that blocks radiation.
- The technician will step behind a window barrier and turn on the X-ray machine.
- You’ll need to stay still and hold your breath while the beams pass through your body.
- This only takes a few seconds.
- If you move, it may blur the image.
You may hear some clicking or buzzing noises while you get your X-ray, but you won’t feel anything. An X-ray is painless. In some cases, you may need to stand next to the X-ray machine. Your doctor may also ask that you get images from the front and the side of your spine, or while you stretch or bend.
An X-ray takes about 5 minutes to complete. But you may be in the room for longer, depending on how many images and views your doctor needs. When your X-ray session is done, the technician will process the images. They may ask you to wait a few minutes to make sure the pictures are clear. Your doctor, or sometimes a specialist called a, will look over your spinal X-rays.
You’ll discuss the results with your doctor, who will explain what it all means and what comes next. © 2023 WebMD, LLC. All rights reserved. : What Is a Spinal X-Ray?
- 1 What does an X-ray show for lower back pain?
- 2 Why doesn’t lower back pain show up in X-ray?
- 3 Can an X-ray show inflammation in the back?
- 4 Do I need a scan for lower back pain?
- 5 Will an MRI show a pinched nerve in the lower back?
- 6 Is lower back pain hard to prove?
- 7 Does inflammation show on scans?
What does an X-ray show for lower back pain?
Reasons for the procedure – X-rays of the spine, neck, or back may be performed to diagnose the cause of back or neck pain, fractures or broken bones, arthritis, spondylolisthesis (the dislocation or slipping of 1 vertebrae over the 1 below it), degeneration of the disks, tumors, abnormalities in the curvature of the spine like kyphosis or scoliosis, or congenital abnormalities.
Why doesn’t lower back pain show up in X-ray?
Why Your Spine Specialist Isn’t Ordering An X-Ray – An x-ray sends radiation in the form of electromagnetic waves through our body, and as these waves pass through they are absorbed by different structures. Calcium in our bones absorbs the most radiation, which is why bones appear so prominently in x-rays.
Fat and other soft tissues absorb less of these waves, meaning they often appear gray or faded on the x-ray image. For this reason, x-rays are typically ordered when injury cause and symptom description suggest a person might be dealing with a spinal fracture or similar bone issue. This is most common when the cause of injury involves significant trauma to the area.
For example, after a car accident, a heavy collision in sporting activities or following a fall, a spine specialist may order an x-ray to see if a fracture has occurred to any of the vertebrae in the spine. In most cases of trauma to the area, an x-ray can be a helpful diagnostic tool.
On the flip side, there are times when an x-ray may not be your best option. In situations where back pain develops without direct trauma to the area, it may be unlikely to get all the answers you seek by ordering an x-ray. If pain develops after bending, twisting or being in the same position for hours, you’re likely dealing with a muscle, ligament or similar soft tissue injury.
These are the same soft tissues that do a poor job absorbing electromagnetic waves, so it would be hard to see problems with these areas via an x-ray. Instead, an MRI would likely be ordered.
Can an X-ray show inflammation in the back?
Pros and cons of X-rays for AS – X-rays have been the gold standard for diagnosing and monitoring AS for many years. They are also less expensive than MRI or CT scans. One disadvantage is that an X-ray does not show damage to tissues. Inflammation is a common feature of AS, and it can damage joints and connective tissues.
X-rays cannot show whether inflammation is present, while MRI scans can. In addition, it may take 7–10 years for damage to the sacroiliac joints to show up on an X-ray. Finally, X-rays of the spine and pelvis involve a relatively high dose of radioactivity to produce a clear image. Repeated exposure over many years may increase the risk of cancer, making X-rays less suitable, particularly for younger people, according to experts,
MRI technology uses a magnetic field and radio waves to take pictures of the inside of the body. No radioactivity is involved. MRI is the most sensitive form of imaging available for AS. It can reveal :
the same bone changes that X-rays can showdisk herniation, better known as slipped disksinflammation of the bone and soft tissues damage to soft tissues
These scans may be especially useful for a doctor making a diagnosis, as they can detect early AS symptoms and changes — allowing a person to begin treatment in the early stages. MRI scans can also help doctors monitor the progression of the disease. The disadvantages: MRI scans take longer and cost more than X-rays.
asking detailed questions about symptoms and any limiting of activitiestesting mobilitychecking for complications
Experts are currently looking for new ways to measure the progression of AS. By measuring biomarkers, they may be able to detect changes in inflammation and other activity. However, more research is needed before doctors can use these methods. As part of a wider set of tools, imaging techniques can help doctors detect and monitor AS.
Do I need a scan for lower back pain?
When scans are recommended for low back pain – It is recommended that scans are performed to further assess back and/or leg pain when:
your doctor suspects a serious underlying condition you have severe or increasing weakness in specific muscles in your leg or foot your doctor believes you have nerve compression related to a disc herniation (pushed outside its normal position) which has been present for more than four to six weeks and is severe enough to consider surgery your doctor believes your symptoms are related to pressure on nerves caused by narrowing of the spinal canal (spinal claudication). Scans may then be recommended if your pain has been present for several months and is severe enough to consider surgery.
What is the best scan for back pain?
CT Scan vs. MRI for Back Pain – Like x-rays, CT scans are usually quicker than MRIs. CT scans are the preferred tool for diagnosing severe injuries that need immediate attention, and they are also helpful in locating tumors. Typically, CT scans are better at scanning bone images than MRIs.
Why do I have back pain but nothing shows up on MRI?
What happens when your pain doesn’t show on x-ray or MRI? Here is one of the top three reasons people wind up in my clinic: “I’m hurt and I’ve been to the doctor and nothing shows up on an x-ray or MRI but I can’t do what I want to. No one can find anything wrong with me.” Having a diagnosis or an injury that does not show up on x-ray or MRI is more common in my office than having a diagnosis that does show up on a scan.
While people heavily rely on x-rays, MRIs or CT Scans, the truth is that most everyday aches and pains do not show up on any imaging devices or anything at all. Why is this? Most problems that cause every day aches and pains are muscle related. And while muscle does show up on some scans, it will only show a problem if there is a tear or A LOT of inflammation.
For most people that have pain, it is caused by muscle imbalances, not anything that can be surgically repaired or can be seen on imaging. Another popular phrase I hear: “But my scans showed arthritis so that must be the cause of the pain and there is nothing that can be done about it.” Outside of replacing your joint, there is nothing that can be done to ‘cure’ arthritis.
- But what always perplexes is me is that one joint always seems to have worse arthritis or more pain than the other one.
- To me that is a big red flag.
- Take your knees for example, how does one knee get arthritis faster or more severe than the other.
- Is the one leg walking less than the other leg? Does the one leg do more standing than the other leg? No, for the most part your legs do the same amount of activity.
So why do you have breakdown and pain and arthritis in one leg and not the other? Imbalances, most often in the muscle,are the cause. Let’s continue with the knee example. Say there is pain in the knee. You have been to the doctor and had the tests and the scans and it has come back as arthritis or nothing showed up.
But your knee gets worse when you go up and down the stairs or stand for long periods of time but then if you lay down the pain goes away. So is your arthritis only there part of the time? Why does pain only happen at certain times and not others when doing the same activity? Again, muscle imbalances.
So what is a muscle imbalance? A muscle imbalance could be a number of things, it could be a weak muscle that is giving in and letting the stronger muscles work overtime for it. It could be a muscle that has a lot of knots, and therefore, is not able to relax and stretch out as much as needed in order to function correctly.
- Imagine a piece of string from your hip to your knee.
- Take that string and tie a bunch of knots in it.
- Watch it get shorter.
- Now if that string was connected to something on the other side, it would start to pull on that side.
- This is how knots in the muscle work.
- Those in one muscle can affect all the rest of the muscles and begin to cause pain.
The bottom line is that not all pain is able to be detected on an x-ray or MRI. That does not mean that there is nothing there that needs to be treated or diagnosed. In fact, it means that it is possibly a precursor to something going really wrong and then eventually needing surgery because it eventually winds up torn.
Will an MRI show a pinched nerve in the lower back?
Pinched Nerve Diagnosis & More – FREE MRI Review Patient history and physical examination are typically the first step in diagnosing pinched nerves. Types of symptoms, duration of symptoms, factors that improve/exacerbate symptoms, treatments that have been already tried, and past relevant medical problems/surgeries are all collected during the history.
- The physician completes a physical exam to check for specific symptoms by inspecting the back, assessing gait, and testing the upper and lower extremities for motor strength, reflexes, and range of motion.
- Both history and physical exam contribute to the diagnosis of a pinched nerve, but imaging is necessary to finalize the diagnosis.
X-rays are typically obtained first to look at the overall alignment of the spine and to check for spinal abnormalities such as scoliosis (curve in the spine), that may affect viable treatment options. These 2D results are supplemented with advanced imaging tests such as MRI or CT scans because these show a 3D view of the spine.
MRI scans which show soft tissues, such as nerves and discs, are generally preferred over CT scans which show bony elements. Advanced imaging can show exactly which nerve or nerves are being pinched and what is causing the nerve to be pinched. Together history, physical exam, and imaging are all necessary in order to make a correct diagnosis and design an optimal treatment plan for a pinched nerve.
Dermatomes are areas of the skin and musculature that a single nerve supplies motor and sensory function to. Based on the location and type of symptom (e.g. radiating or shooting pain, numbness, tingling, or loss of muscle strength) knowledge of dermatomes can help identify which spinal nerve may be affected by a pinched nerve.
Is lower back pain hard to prove?
Why Is it Difficult to Diagnose What Causes Lower Back Pain? Many people live with lower back pain, thinking there is nothing that can help them achieve the relief they crave. To compound the problem, there are so many causes of lower back pain, meaning it can be challenging to diagnose, even for trained orthopedists with decades of experience treating back pain.
- Sometimes the reason is more obvious, such as a traumatic injury accident or spine-related deformity.
- The most common cause of lower back pain is torn or pulled connective tissues (tendons and/or ligaments).
- Sprains and strains can happen suddenly, such as lifting heavy objects and twisting the spine, or they can progress slowly over time, for example, from high-impact sports or athletic activities.
Before starting treatment, your orthopedist will perform a physical exam and take your medical history with the goal of diagnosing your condition. Questions your doctor might ask to determine a diagnosis for your lower back pain include:
Is your pain worse at certain times of the day?Has your pain spread?Do you have other symptoms, such as numbness or weakness?What does the pain feel like (dull, stinging, aching, etc.)?Do you have an active or more sedentary lifestyle?What are your sleep habits/postures?Have you had any recent injuries?
When is back pain not serious?
5 signs your back pain might be an emergency About 80% of adults will experience back pain in their lives, so it’s important to be able to identify the severity of your symptoms.
In our 20s and 30s, “normal” back pain often can be attributed to factors of daily life, such as sitting too long, picking up children, or overdoing it while exercising. In our 40s and older, work injuries and the beginnings of arthritis and degenerative conditions are more common.Back pain is so common, in fact, that many patients shrug off symptoms that might indicate a medical emergency.Approximately 80% of adults will experience back pain in their lives, so it’s important to be able to identify the severity of your symptoms and track how long the pain lasts.
If back pain can be associated with a specific activity, such as lifting or twisting wrong, and the pain goes away within 72 hours after resting and applying ice, it’s usually nothing to worry about. However, if pain creeps on gradually, appears suddenly, or doesn’t go away, you might have a more serious condition.
Can you see inflammation on a scan?
A CT scan will identify inflamed diverticula, bowel wall inflammation, pericolic fat stranding, and corresponding complications. CT is capable of visualizing pericolonic and colonic complications which results in a more accurate diagnosis for the patient, along with better standard of care.
Does inflammation show on scans?
Discussion – MRI is an imaging method that is very sensitive in detecting inflammation and also bone erosions. This makes MRI an interesting tool to measure the course of the disease in randomised clinical trials and this suggests that MRI may also be useful in the diagnostic process.
When MRI would be implemented in practice in the diagnostic workup of joint symptoms, it is crucial to consider the prevalence of MRI features in the general population to prevent false-positive findings due to positive labelling of features that are (also) present in the normal situation. We reviewed the literature systematically to get an overview of the reported prevalence of features in symptom-free persons.
The large majority of these studies were not designed to determine the frequencies of MRI features in the general population but used symptom-free persons as the control group. In addition, there were considerable differences in methodology of the selection of volunteers, MRI protocols and MRI scoring.
- This resulted in heterogeneous data.
- Indeed, considerable differences in the frequencies of MRI features in symptom-free persons were observed in the different studies.
- We combined the data of the studies that had similar scanning and scoring protocols and, based on the data available, we observed that all MRI features studied were present regularly and that MRI detected erosions were present most frequently (in 33–52% of symptom-free persons).
Most studies described their findings at the patient/joint region level and not at the level of individual bones or joints. However, studies that did include evaluation at the bone level showed that most lesions were mild (RAMRIS of 1). Furthermore, we noted a lower prevalence of all MRI features (erosions in particular) in studies not using RAMRIS than in those using the RAMRIS method.
- This may possibly reflect that the RAMRIS method is sensitive and that radiologists evaluating the MRIs using clinical experience may more often report an MRI as normal.
- Additionally, most of the studies that did not use the RAMRIS method were done when MRI techniques were less developed.11, 12, 14–22, 24, 25, 44 Of all MRI features, the prevalence of synovitis varied the most between studies.
This cannot be explained only by the absence or presence of contrast enhancement that may increase the sensitivity and specificity of identifying MRI-detected synovitis as both types of studies were evaluated separately.42, 45, 46 The reasons for these differences between studies are unclear to us.
The most important limitation of this review is the heterogeneity of the data collected, which is a result of the methods with which data were collected in the individual studies. For instance, in many studies the symptom-free persons were used as the control-group and information on how the symptom-free persons were recruited was missing.
Some studies included symptom-free persons only and did not use the symptom-free persons as controls.22, 23, 28, 30, 32, 36 A consequence of this latter approach is that the evaluators per definition were aware that they had evaluated scans of symptom-free persons.
- Hypothetically, awareness of the clinical status may affect the scoring with lower scores being given to symptom-free individuals.
- In addition, the methodology to rule out rheumatic diseases differed between the studies.
- A difficult issue is to what extent osteoarthritis was ruled out; joint space narrowing or other osteoarthritic features were not assessed in these studies, so no definite conclusions can be drawn as to what extent the presence of asymptomatic osteoarthritis has affected the results.
Furthermore, recent studies indicated that ACPA can affect the bone in the absence of clinically apparent arthritis and that subclinical inflammation may precede clinical arthritis.9, 10 In two studies, the symptom-free persons underwent laboratory testing and in three studies the symptom-free persons were even followed (for 1–5 years); none of these persons developed RA.
- Another important limitation relates to the issue when it is allowed to combine the results of different studies.
- We combined results of studies that used similar scan protocols (same joints and uniformity in contrast enhancement) and similar scoring protocols.
- Still, the summary measures that we provided should be interpreted with care as the readers of the different studies were not trained together and inter-reader differences and other causes of heterogeneity most likely exist.
Nevertheless, this review gives a first impression of the MRI features present in the general population. It can be argued that more stringent quality criteria should be applied before it is acceptable to combine the results of different studies. For instance, the following quality criteria might be reasonable: (1) the recruitment method was described, (2) appropriate methodology was used to exclude persons with joint symptoms or joint disease, (3) the field strength of the MRI was ≥1 T and (4) scans were scored according to the RAMRIS method.