TEST EXAMS

If you are experiencing back and/or neck pain, forward and backward bending x-rays may help your doctor assess any potential causes of spinal instability. Your doctor may recommend an x-ray to:

• Determine whether a bone is broken, chipped or dislocated
• Evaluate joint injuries and bone infections
• Examine the bones or discs in your spine
• Diagnose and monitor the progression of degenerative spinal conditions, such as osteoporosis.
• Check for scoliosis

During an x-ray exam, you will lie on a table, or sit or stand between the x-ray machine and an x-ray film or plate. The technologist or radiologist will then aim the machine at the area of your body to be examined; usually, the area will be filmed from several different angles. The images are recorded digitally or on film, and viewed within minutes. A radiologist typically views and interprets the results, then sends a report to your doctor.

An x-ray exam may be done at a hospital, outpatient facility or even at your doctor’s office. After the test you can resume your normal activities.

Because the level of radiation you’re exposed to during the exam is so small, there is minimal risk involved; however, please advise your doctor if you are pregnant, have asthma or allergies or a medical condition.

Before undergoing your exam, please ask your doctor or a member of the office staff about any specific pre- or post-exam instructions they may recommend.

During the scan, you will lie on a table inside a doughnut-shaped machine called a gantry. The x-ray tube inside the gantry will rotate around your body, sending small doses of radiation through it at various angles. As the x-rays pass through, the tissues inside your body absorb the radiation in differing amounts. Detectors in the machine measure the radiation that leaves your body and converts it into signals that are transmitted to the computer. The computer creates images that reflect the signals intensity and displays them on a computer monitor. A radiologist interprets these images and sends a report to your doctor.

A CAT/CT scan may be done either at a hospital or outpatient facility. Some require that you ingest a contrast medium to help highlight interior structures. This may be done by mouth, enema or injection (intravenously), and may require that you go without food for a few hours before the test.

CAT/CT scans are painless; after the test you can resume your normal activities. The risks involved are the same as those of conventional x-rays; please advise your doctor if you are pregnant, have asthma or allergies or a medical condition such as diabetes, heart disease or thyroid problems.

Before undergoing your exam, please ask your doctor or a member of the office staff about any special pre- or post-exam instructions.

Because they provide such exceptional detail, they are a very useful test for diagnosing conditions affecting not only the bones of the spine (vertebrae), but the discs, spinal cord and nerves and connective and other soft tissues.

An MRI machine consists of a large magnet with a hollow tube running through it, called the bore. During the scan, you will lie on a table that slides into the tunnel of the bore. Straps and bolsters may be used to help you stay still and maintain the correct position during imaging. Small devices capable of sending and receiving radio waves may be placed on or near the area of the body to be scanned. Some MRI units, called short-bore systems, are designed so that the magnet does not completely surround you; others are open on all sides.

Some MRI scans require that you ingest a contrast medium to help highlight interior structures. If a contrast material is needed, it will be done through an intravenous line inserted into a vein in your hand or arm. During the scan, you will be moved into the magnet of the MRI unit and the radiologist and technologist will leave the room while the scan is underway and the images are being recorded.

An MRI scan may be done either at a hospital or outpatient facility, and is typically completed in less than an hour. MRI scans are painless; after the test you can resume your normal activities.

Because MRI uses low-energy, non-ionizing radio waves, there are no known risks or side effects. Since it uses no radiation, MRI scanning may be repeated with no known adverse effects.

However, please advise your doctor if you are pregnant, have asthma or allergies, a medical condition, or any implanted medical or electronic device. If you have a cardiac pacemaker, you cannot receive an MRI and should not enter an MRI area.

Before undergoing an MRI, please ask your doctor or a member of the office staff about any special pre- or post-exam instructions.

Abnormalities within the spinal canal can potentially be identified to aid in the diagnosis of certain spinal problems, such as nerve compression or a disc rupture.

A myelogram may be used to identify:

• The cause of arm or leg numbness, weakness, or pain.
• Narrowing of the spinal canal (spinal stenosis)
• A tumor or infection causing problems with the spinal cord or nerve roots.
• A spinal disc that has ruptured (herniated disc).
• Inflammation of the membrane that covers the brain and spinal cord.
• Problems with the blood supply to the spine.

During the exam, you will lie on your stomach or side on an x-ray table. A local anesthetic will be placed on the skin over the test area, and with the assistance of fluoroscopy (x-ray guidance imaging), your doctor will insert a thin needle into the spinal canal for placement of the dye. A sample of spinal canal fluid (cerebrospinal fluid) may be taken before the dye is put in the canal.

After the dye is injected, x-ray images will be taken. When the exam is complete, the needle will be removed and your exam area cleaned and bandaged. Following the myelogram, you’ll be taken to a recovery area where you’ll rest lying down with your head elevated for several hours.

For at least 24 hours after your exam, quiet non-strenuous activities are recommended to allow your puncture site to heal. You should also drink plenty of fluids (e.g., water, juice) to help clear the dye from your body.

There is some risk associated with a myelogram. Possible side effects include:

• Nausea or headache, which may last for up to 24 hours.
• Seizure (following injection of the dye into the spinal canal, or if the dye moves into the brain).
• Allergic reaction to the dye
• Kidney complications in patients taking metformin for diabetes control
• Inflammation, weakness, numbness, paralysis or loss of bowel control (rare)
• Also in rare cases, the dye may cause blockage of the spinal canal. If this occurs, surgery is usually required.
• Radiation damage to cells or tissue.

Before undergoing your exam, please advise your doctor of any medical conditions or allergies you may have, or medications that you’re taking. Also ask your doctor or a member of his staff about any specific pre- or post-exam instructions they may have.

A discogram may be used to detect structural damage in the disc, and can help your doctor determine whether a spinal disc is the cause of localized or radiating back or neck pain. A discogram will show if a disc has begun to rupture, or herniate, or has developed tears in its outer shell.

During the exam, using a fluoroscope for guidance, your doctor will insert a spinal needle into the disc and inject radiopaque dye into the nucleus (center) of the disc. In a healthy disc, the dye will remain contained within the central nucleus. After the dye is inserted into the disc, your doctor will take a series of X-rays. If the X-rays show the dye leaking out of the nucleus into the surrounding tissue, the disc is considered abnormal. If the symptoms you’ve been experiencing are replicated as a result of the test, it’s a good indication the disc is the cause. A CAT/CT scan also may be done to examine a cross-section of the disc.

A discogram may be done either at a hospital or outpatient facility. There will be an anesthesiologist or a nurse present during the procedure to monitor you and administer intravenous sedation to keep you relaxed. Your heart, blood pressure and blood oxygen will be monitored closely.

For at least 24 hours after your exam, quiet non-strenuous activities are recommended to allow your puncture site to heal. You should also drink plenty of fluids (e.g. water, juice) to help clear the dye from your body.

Risks associated with the test include infection, bleeding, nerve root irritation or an allergic reaction to the dye.

Before undergoing your exam, please advise your doctor of any medical conditions or allergies you may have, or medications that you’re taking. If you’re taking a blood thinner, you should not have the exam. In addition, please ask your doctor or a member of his staff about any specific pre- or post-exam instructions they may have.

Your doctor will typically recommend a bone scan when there is suspicion of tumor, arthritis, infection, necrosis or small fractures, i.e., conditions that all result in high bone turnover. A bone scan does not replace diagnostic tests such as an MRI, CAT/CT scan or x-ray imaging, but may provide additional information.

During the exam, your doctor will first give you an injection of the radiographic marker, which contains tiny amounts of radioactive materials called tracers, into a vein in your arm. After two to four hours the amount of time it takes for the tracers to be absorbed into your bone you’ll be ready for the actual scan. For the scan, you’ll lie on an exam table while a gamma camera is passed over your body to record the pattern of tracer absorption by your bones. The test may be done in a hospital or outpatient facility, is painless and typically takes about 30 minutes. In some instances, your doctor may order a three-phase bone scan, which involves taking a series of images over a period of time, usually two to four hours.

The risk associated with a bone scan is similar to that of conventional x-ray imaging. There are generally no side effects, and an allergic reaction to the radiographic marker is rare. After the test, you can resume your normal activities.

Before undergoing a bone scan please ask your doctor or a member of the office staff about any special pre- or post-exam instructions.

During the test, the patient lies fully clothed on a padded table while the DEXA scanner beams x-rays from two sources towards the bone being examined (usually the lower spine or hip). A radiation detector device is slowly passed over the examination area, producing images that are projected onto a monitor. A computer then analyzes the images and calculates bone density based on the amount of radiation absorbed by the bone (the denser the bone, the more radiation it absorbs).

The test, which may take up to 30 minutes, is performed by a physician or technician and requires no injections, sedation, special diet or any other advance preparation.

DEXA scans are painless; after the test you can resume your normal activities. The risks involved are the same as those of conventional x-rays; please advise your doctor if you are pregnant, have asthma or allergies or a medical condition such as diabetes, heart disease or thyroid problems.

Before undergoing your exam, please ask your doctor or a member of the office staff about any special pre- or post-exam instructions.