3 Aug, 2022
Mustafa Alnaib is a doctor, orthopaedic surgeon, and musculoskeletal specialist with over 15 years of experience. He treats patients for back pain at ACTIVATE | Musculoskeletal Clinic, his practice in Kent. Scan.com are pleased to partner with him to bring you this comprehensive guide to back pain, and how medical imaging is vital for accessing the right diagnosis and treatment pathways.
Back pain can have many causes, and can commonly be the result of an injury such as a muscle sprain. Sometimes, other conditions like a slipped disc, trapped nerve or arthritis can lead to back pain, and other symptoms like numbness or tingling.
Very rarely, back pain can be a sign of a more serious problem such as a fracture, cancer or an infection. MRI scans can help your clinician to rule out certain issues, or confirm a diagnosis to help you access the onward care you need.
MRI is the gold standard imaging modality for the spine. This is because MRI scans can provide high quality images of a range of different body tissues all in one image, such as soft tissues and bones. It is also a safe and non-invasive procedure, with no radiation involved.
MRI is highly sensitive and specific for diagnosing spinal conditions including cord or nerve compressions, infections, cancer and fractures. However, a CT scan is the gold standard for diagnosing and planning the management and treatment of spinal fractures.
While X-rays can also be useful for diagnosing fractures and other bone abnormalities, they are not as reliable as MRI scans for diagnosing disc, spinal cord or nerve problems. Moreover, MRI scans can also demonstrate problems in the bones of the spine (vertebrae) in more detail.
MRI scans have high sensitivity and specificity in picking up many conditions affecting the spine. A good example is back pain that is accompanied with leg weakness or numbness – often an indication that there is a condition affecting the spinal cord or the nerves, like a disc prolapse or narrowing of the spinal canal.
MRI scans can also be used to identify conditions including arthritis, infection or trauma, and tumours to the spine. It can also tell us quite reliably whether a patient has spinal cancer or not.
The area of your spine that needs scanning will depend on your symptoms, and you might need to book an MRI of the whole spine in some cases. The three common spinal MRI scans are:
Cervical spine - the neck region, consisting of the first 7 vertebrae between the skull and the base of the neck.
Thoracic spine - the middle of the back, and the longest part of the spine, comprised of 12 vertebrae from around the top of the shoulder area down to the abdomen. The thoracic spine also connects to the rib cage.
Lumbar spine - the lower back, made up oft 5 vertebrae between the ribs and pelvis
Sacral spine - the lower end of the spine, comprising of 5 vertebrae and articulating with the pelvis via the sacroiliac joints on both sides
Scan.com also offers separate scans of the sacroiliac joints and coccyx (tailbone at the base of your spine).
If you are having one section of the spine scanned, it will usually take between 10-30 minutes, and can last longer if a contrast agent is required. A scan of the whole spine can last from 30-60 minutes.
While ultrasound is not usually useful for the diagnosis of back pain, it can be used to guide injections into the spine as part of your treatment plan. Ultrasound can be used to identify some congenital spinal disorders in young children, but for adults, MRI is the recommended modality for diagnosing spinal problems.
Many back pain symptoms are caused by lifestyle factors, such as poor posture, sitting for too long, and working in roles that require bending or lifting. To treat these kinds of issues, lifestyle adjustments such as increased movement, along with physiotherapy, can help to improve symptoms.
Painkillers can also be taken to manage pain during the course of treatment.
In some cases, injections or surgery might be necessary to treat the causes of back pain. If a tumour is discovered, further tests may be required to determine the best treatment pathway and prompt referral to specialist centres
Timely, convenient and affordable access to MRI is invaluable, as it speeds up the process of diagnosing back problems, and helps guide management and plan treatments that are personalised to the patient.
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