Diagnosing the Cause of Back Pain: X-Rays

Medical imaging studies are usually the first diagnostic tests doctor will order after the physical examination, if he or she thinks that there is a problem with the soft tissues of the spine. The three most common medical imaging studies ordered are X-Rays, CT Scans (Computed Tomography) and MRI (Magnetic Resonance Imaging). The most common type of imaging test ordered is the X-Ray. The X-Ray is by far the cheapest of these three options and does provide the doctor with a lot of information about your spine. These tests are relatively safe, and the technicians who perform these tests will do everything possible to ensure the safety of the patient. X-rays produce black and white images, that show good detail of the bones of the vertebral spine and some of its soft tissues. On an X-ray, the bones of the vertebral spine, as well as the sacrum and pelvis show up white, while most of the other soft tissues show up dark or black. Using the information available in the X-Ray films, doctors will be able to determine if a bone has been injured or fractured.



Doctors may also be able to determine whether the curvature of the spine is normal or abnormal, based on the detail offered on the images. In a typical test, the doctor order an examine a frontal and lateral view of the spine. The frontal view of the X-ray will present a straight spine on a vertical axis, in a healthy male or female. An abnormal frontal view on an X-Ray would show a curvature of the spine vertically, indicating spinal abnormalities such as scoliosis. On a lateral view of the spine, the X-Ray will show the four curvatures of the spine (Lordosis and Kyphosis). The lateral or side view of the X-ray will show whether the curvatures are present as well as the degree of angles. Exaggerated curvatures of the spine, also known as Lordosis and Kyphosis, may lead to difficulty breathing abnormal posture (humpback) and back pain. X-rays show good detail of the vertebral bones, and bone abnormalities such as osteophytes (bone spurs), injuries, fractures, and osteoporosis.

X-rays use a chemical process called electromagnetic radiation, which involves send invisible light energy through our body and hitting an image receptor behind it - producing an images of our body's bones, organs, and soft tissues. When the light energy manages to pass all the way through our body, without being absorbed, that part of the image comes out black. In the regions of our body where the energy is absorbed, the area behind it on the film comes out white. This black/white contrast gives the doctor a lot of information about our spine and other body structures.

X-rays have their limitations, as they show detail of bones very well, but not soft tissues or organs very well. These tests are very good at showing broken bones and hairline fractures. X-rays are also good at showing abnormal fluid levels in body cavities that aren't supposed to contain fluid, and abnormal pockets or air in body cavities that aren't supposed to contain air. X-Rays are good at showing structures that indicate pathology, such as kidney stones, gallstones, and tumors in the lungs.

X-rays aren't very good at showing soft tissue damage, unless a contrast agent is introduced into the area being X-rayed. For more information about the soft tissues, a CT or MRI may be ordered.