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Usually the first person to be consulted is the GP who might refer you either to the local hospital or directly to a neuroscience unit for tests. If the symptoms have developed very gradually, an outpatient appointment is usually arranged. If there is some suspicion that the symptoms could be caused by spread of a known cancer to the spine, tests will usually be arranged by the doctors who have been treating the cancer.

Although ordinary spinal X-rays are important, a firm diagnosis can usually only be reached after an MRI (magnetic resonance imaging) scan and possibly, a biopsy (see page 13).

MRI (Magnetic Resonance Imaging) scan
An MRI scanner does not use x-rays, instead pictures of the spine are produced by a strong magnetic field and radiowaves. Before you are scanned, you will be asked to complete a safety questionnaire because of the very strong magnetic field around the scanner. For example, if you have had a heart pacemaker fitted, you cannot be scanned. If you have any other metal in your body, such as a joint replacement or heart valve, you should check with the MRI department whether it is safe for you to be scanned.

The length of time of the examination will depend on how much of the spine is scanned. An average scan time would be around 30 minutes. MRI contrast (sometimes called dye) may be injected into a vein in the arm, to help show any area of abnormality. During the scan, you will be asked to lie on a couch, which is moved into a long tube.The scan is painless, but the scanner is very noisy – you will probably be offered earplugs or headphones to deaden the noise. Some people do find the MRI scanner rather claustrophobic – trying to keep your breathing slow and steady will help you to stay relaxed. Also, if you take a friend or relative along, they should be able to accompany you into the scan room.

CT myelography
A myelogram involves the injection of some contrast (or dye) into the spine by lumbar puncture. Lumbar puncture is sometimes uncomfortable but a small injection of local anaesthetic is given to numb the area first. X-ray pictures are then taken of the dye moving in the cerebrospinal fluid (CSF) which surrounds the spinal cord and nerves (myelography). Any areas of abnormality are then examined on a CT (computerised tomography) scanner. CT uses X-ray sections through the body to allow more detailed assessment of any area of abnormality shown on the myelogram films.

Isotope bone scan
This involves the injection of a very small dose of a radioactive chemical into a vein.The chemical is concentrated in abnormal bone and can be photographed after a delay using X-ray film. It is only done if bony disease is suspected. Once injected, there is too little radioactivity to affect anyone else.

What will these tests reveal?
The plain X-rays will show whether the bones of the spine are structurally sound.The scans will show whether there is any pressure on the spinal cord or nerves due to a tumour or any other sort of lump. CT or PET scans may also be carried out to check for primary tumours elsewhere in the body, if biopsy samples prove inconclusive. The exact location of the abnormality will have been shown and a mark may be made on the overlying skin after completion of the scan.This is to help with planning treatment.