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In the majority of cases an experienced doctor can diagnose the cause of spinal pain by clinical features. By this we mean a person’s symptoms and the physical signs noted during an examination. When there is doubt a variety of special investigations can be carried out.

X-rays and blood tests
A combination of simple blood tests and plain radiographs - the proper name for X-ray pictures - will usually rule out any serious diseases or other conditions that require urgent treatment. Certain rare disorders affecting the nerves will not show up and sometimes more detailed investigations are needed, particularly if a person’s symptoms do not settle down in a reasonable period of time.

MRI scanning
MRI or Magnetic Resonance Imaging is the most advanced way of producing a picture of the spine, as well as other parts of the body. It relies upon highpowered magnetic fields and radiowave energy, rather than X-rays or other potentially harmful forms of radiation. As far as we know, the energy forms used in MRI scanning have no harmful effects on body tissues.

MRI scanning produces high-quality images and can effectively be used to
diagnose most cases of spinal degenerative disease, as well as ruling out more serious disorders. The equipment is very expensive but it is gradually becoming more widely available and in time will become the principal means of investigating spinal pain after plain radiographs and blood tests.

CT scanning
In units where MRI scanning is not available, CT scans still provide a useful means of investigating spinal disorders. Equally valuable when introduced, CT imaging is rapidly being replaced by MRI scanning in the diagnosis of spinal disorders. CT scans do, however, still give better detail of bone and may be preferred to MRI in some circumstances.

Myelography
For many years myelography was the only special investigation available to doctors to investigate spinal disorders. It involves the injection of a contrast medium (often referred to as a ‘dye’) into the spine. The patient is then tipped up and down on an X-ray table while radiographic images are taken. The technique is invasive, which is why modern scanning techniques are now preferred. Myelography nevertheless still has a role to play on occasions.

Media publicity about a condition known as arachnoiditis resulting from
myelography caused a good deal of concern at one time among patients who had undergone this form of investigation. It is true that use in the past of a contrast medium known as Myodil may have caused the later development of unpleasant symptoms in a small proportion of people. Most patients who received Myodil were, however, unaffected. Furthermore, modern contrast materials, in use for the past 15 years, do not cause arachnoiditis.

Other investigations
Sometimes electrophysiological tests are used to investigate the functioning of individual nerves. These tests involve low energy electrical stimulation of skin and muscles. They cause only minor discomfort and are usually performed on an out-patient basis.

The technique of discography involves injection of a contrast medium into the intervertebral disc itself. X-ray images then show the structure of the disc. The investigation is carried out on an in-patient basis. It is somewhat uncomfortable at times but, by reproducing a patient’s pain, a doctor can often gain useful information about its site of origin.

A simpler form of scanning, known as isotope scanning, is occasionally used to look for generalised disease processes that can affect the spine as well as other bones. Sometimes various investigations are combined, for example CT scanning may be performed after myelography or following discography.