Lower Back Pain Diagnosis
It is important for chronic back pain sufferers to understand how difficult it is to diagnose back problems such as bulging discs and herniated discs with certainty, and that it is even more difficult to pinpoint the source of a back ailment. Though bulging discs and herniated discs may be the immediate cause of back pain, they may not be the true cause. For example the true cause of your back problem that caused the herniated or bulging disc could be bad posture, bad sleep position, poor nutrition, and abnormal curvature (kyphosis or lordosis) of the back.
Arriving at a lower back pain diagnosis as a result of a physical examination from your doctor and associated diagnostic studies are also difficult. An X-ray for example, does not show the majority of the anatomy of the back, and especially not of the soft tissue. A regular X-Ray only shows a two dimensional view of the anatomic parts, and only produces a black and white picture on film and screens. An X-ray shows some soft tissue, but mostly reveals bone. When taking pictures of the lumbar and cervical spine, the X-Ray images show the vertebrae of the spine floating beneath one another. The intervertebral discs that are located between these vertebrae do not absorb X-rays that pass hit them as the radiographer is taking an exposure, and thus show up as black on X-Ray film. Anatomical parts, such as teeth and bones, absorb X-rays that bombard them, causing those parts to come out white on an X-Ray film/computer screen. Anatomic parts such as joint cartilage and lung tissue absorb far fewer X-rays, causing their parts to come out blacker on an X-ray film/image.
Because bones come out white on an image and discs and joint come out black, we can infer information about joints indirectly, by measuring the amount of space between the bones. This principle especially applied to the vertebral bones of the spine, and the intervertebral discs that separate them. Radiologists and other doctors, when looking at X-Rays, can judge the health of the discs by the amount of space between them. When doctors observe that the two discs have very little space between them, they diagnose the patient's back problem as degenerative disc disease.
What does an X-ray of narrowed space tell us, in terms of the cause of back pain. Unfortunately, it tells doctors, very little. These results will not enable doctors to provide the patient with a diagnosis, but rather point them in a particular direction. A narrowed space between the lumbar vertebrae may indicate that the patient has a herniated disc. Other tests may confirm that the patient has a bulging disc or herniated disc, or if the patient has a condition known as spinal stenosis. Spinal stenosis is a narrowing of the spinal canal that houses the meninges of the spine as well as the spinal cord.
Doctors may order a test called a myelogram to get a more detailed view of the spinal canal. In a myelogram, A myelogram involves the injection of a contrast dye into the spine before an X-ray examination to highlight structures of the spine that would not be easily visible in an X-ray without contrast.