When you have a back/neck injury or pain, diagnostic testing needs to be performed before any treatment can be decided upon. The first thing you will have is an x-ray. An x-ray will show if there are fractures of any of the vertebral bones and/or disc problems. The spine is divided into four parts. So there are four common types of spinal X-rays:
Cervical spine X-ray. This X-ray test takes pictures of the 7 neck (cervical) bones.
Thoracic spine X-ray. This X-ray test takes pictures of the 12 chest (thoracic) bones.
Lumbosacral spine X-ray. This X-ray test takes pictures of the 5 bones of the lower back (lumbar vertebrae) and a view of the 5 fused bones at the bottom of the spine (sacrum).
Sacrum/coccyx X-ray. This X-ray test takes a detailed view of the 5 fused bones at the bottom of the spine (sacrum) and the 4 small bones of the tailbone (coccyx).
The most common spinal X-rays are of the cervical vertebrae (C-spine films) and lumbosacral vertebrae (LS-spine films).
I had the lumbosacral x-ray myself.
If a disc problem is seen on x-ray, like it was on mine, the next thing that will be ordered is an MRI. An MRI or Magnetic Resonance Image will offer a more detailed view of the spine and it’s structures. X-rays show bones really well but as far as soft structures, they appear only vaguely. On MRI all the structures can be seen very clearly as in the photo I have on this post. In this image you can clearly see one of the discs bulging outward (herniated) shown by the bottom arrow.
The MRI machine is like a tunnel. You will have to lie on your back on a moving surface, it is very cold in the room they keep this machine in because it generates so much heat when it is in operation so wear something warm. You cannot have any metal on you when having this test so remove all jewelry especially from piercings which can be overlooked and all clothing with metal including your bra. If a person wears metal into this machine it can be lethal (seriously, it can be). They will tuck a blanket around you if you ask. If you are claustrophobic, be sure to tell your doctor beforehand because he can write you a prescription for something for you to take about an hour before to relax you. Last time (a week ago today) my doctor gave me Valium and it knocked me out almost completely and I only took (1) 10mg tab, the rx had 2 in it and said to take both. Both would have probably knocked me out until the weekend! Of course if you take something, you have to bring a driver with you. I didn’t think I was claustrophobic until the first time I had an MRI. There are 2 types: closed end and open end MRI machines. Many times if a person is seriously overweight they won’t fit in a closed end MRI so they have to be put in the open ended one, it can be used for severe claustrophobia as well but I have had a few doctors tell me that they don’t like the images produced by the open ended machines so they don’t like to use them unless they absolutely have to. Once you are lying on the moving surface and comfortable with your arms at your sides, you will feel it raising you up to the level of the opening of the machine, then it starts to slide you in head first. At this point the tech leaves the room. The first time I ever had one, they started to put me in there and 3 different times I said “stop” because it made me feel panicky and they brought me back out. That time I decided it was mind over matter so I told them to just go ahead so I didn’t have to reschedule but the next time I knew to ask for that rx. The test starts and a tech will talk to you on a speaker and tell you how long each stage will last so you won’t move during that time. You can breathe normally but you can’t re-adjust your position during any of the stages only between them. Each stage lasts between 2-10 minutes or so and usually the surface you are lying on moves further into the machine for each one so it can get a number of views of the area. The machine makes loud buzzing and knocking noises and to me it sounds I am inside a dryer with a pair of sneakers, they give you earplugs to muffle that noise a bit. The tunnel feels like it is just barely bigger than you are and looks kind of like the inside of a plane because of the shape and that it has narrow bands of lights down each side. I find it best to keep my eyes closed most of the time I am in there and try and go to my “happy place” in my mind. My mom told me one time that she mentally redecorates a room while she is in there, I tried that and that was a good way to pass the time. The entire test can take anywhere from 30-60 minutes total.
In my case, the MRI showed that my L5 disc was nearly completely compressed and had very little space between the vertebrae and this is causing pressure on the sciatic nerve. “A disc herniation tends to put pressure on the weakest spot in a disc, an area that happens to be right under the nerve root. This results in pain that can radiate all the way down the sciatic nerve throughout a person’s leg and into the foot. Depending on the nerve root affected.” In my case this causes pain to radiate from the center of my back around my hip and down the side of my right leg sometimes all the way to the ankle and sometimes it feels hot like I am standing too close to a bonfire. It has been a constant pain since December of 2011 sometimes sharp, sometimes dull but completely unrelenting.
On the other side, I have a herniation and some compression on L3 which has caused the S1 nerve to be irritated. The pain on that side comes around my hip and down the back of my thigh to my knee, never farther than that. This pain is usually fairly dull and more like an ache but can also feel hot at times too.
- “Pinched nerve at S1. Impingement of the S1 nerve can lead to weakness with the large gastronemius muscle in the back of the calf, causing difficulty with foot push off (view the distribution of skin innervation with Numbness for the S1 nerve runs on the outside of the foot. The S1 nerve root also supplies innervation for the ankle jerk (tap on the achilles tendon and the foot goes down), and a loss of this reflex indicates S1 impingement, although it does not create loss of function.”