Diagnosing Back Pain: Flouroscopy

X-Rays are the most common test done to look at the health and structural integrity of the spine. X-Rays use very high frequency light rays , which shoot through a patient and produce an image of the body on radiographic film or computer screen. We get an image of the body based on the differences in anatomical parts on the x-ray. Some of the X-Rays that impact the body have enough energy to pass all the way through to body, to the image receptor on the other side. Some of the X-Rays are absorbed by the body. At the locations of the image receptor where the X-Rays were able to pass through the body part, the X-Rays show up as black on the images that we and the doctors can see. At locations where the body tissues absorbed the X-rays, the images on the x-rays show up as white. The contrast of blacks and whites on the X-Ray provides the doctor with a lot of information towards diagnosing or ruling out certain causes of back pain.



X-Rays provide doctors with a lot of information about the bones, joints, and structural integrity of the spine. X-rays doctors with a lot of indirect information about the joints of the spine, and conditions such as degenerative joint disease, facet joint arthritis, and sacroiliac joint dysfunction. The reason why we obtain indirect observations of the joints of the spine and joint dysfunction is because the cartilage in joints and of the soft tissues are not nearly as dense as the bones of the spine, pelvis, sacrum, and coccyx. Because of the low density of these joints and soft tissues, they show up black on non-contrast X-Rays. To obtain more detailed views of the soft tissues, joints, and intervertebral discs, X-Rays must be done with the injection of contrast dyes, or CT Scans or MRIs must be ordered.

Two questions that you may be asking are:
  1. What information do X-Rays give to doctors concerning the cause and possible treatment of back pain.
  2. If other diagnostic tests give more detailed views of the structures of the back, then why don't we just do those first.
There are three reasons that X-Rays are likely to e performed first, in order to diagnose the cause of a patient's back problem.
  1. Diagnostic X-Rays are revealing at diagnosing many spinal abnormalities and for confirming or ruling out many back conditions. X-Rays do show very good detail of the bones, ribs, coccyx and sacrum, and pelvis. If there are issues relating to pathology, osteophytes (bone spurs), and dislocations of the spine, X-Rays will be good at presenting these conditions.
  2. X-rays are a good economical alternative to CT Scans and MRIs. Both of those types of studies are very expensive, and insurance companies often won't approve of them before X-rays are taken, to rule out conditions such as degenerative joint disease. If the results of X-rays suggest the possibility of serious conditions such as herniated discs, then those studies may be done subsequently.
  3. Serious degenerative conditions of the spine are relatively rare, rendering other types of tests unnecessary in most cases. CT Scans involve giving the patient nearly 100 times more radiation than X-Rays, which is another reason to hold off these types of tests unless deemed necessary by the doctors.
  4. X-Rays are useful both as a diagnostic and treatment tool. Many studies involve the use of X-Ray Flouroscopy, which involves radiologists taking live moving video views inside the body, using X-Ray technology. X-Ray with Flouroscopy is typically done with contrast agents being injected into the areas of interest. This Flouroscopy with contrast agents give the doctors to look at live video views of certain sections of the back while other doctors do procedures such as pain injections, laser surgery, and spinal surgery.