When you have a consultation with your physician, your attending clinician will ask you detailed questions about your symptoms and also give you a thorough physical examination. If this does not provide sufficient information in order to clearly localize the causes of your back disorders, it will be necessary to make use of additional imaging procedures. Usually, your orthopedic specialist or radiologist will initially take an X-ray image of your spinal column.
The differing densities of human tissues and bone mean that their permeability to X-ray radiation is variable. The physician is provided with a two-dimensional image specifically of the bony structures by visualizing these X-rays passing through the body on a suitable viewing medium. The bone structure, any fractures and changes related to wear and tear can be well visualized.
The physician will generally also want to have a comprehensive overview of the soft tissues affected, such as tendons, muscles and nerve structures, in order to obtain a comprehensive assessment of your situation. This is achieved by your radiologist taking a series of cross-sectional images (slices) through your body or the affected region using appropriate physical methods. The process used to obtain this three-dimensional image of the condition of your body is known as tomography.
The technology used most frequently is known as magnetic resonance tomography (MRT) or magnetic resonance imaging (MRI). When MRT is carried out your body is gradually passed through a strong magnetic field in which the atomic nuclei of the cells are aligned in accordance with the polarization of the magnet. By overlaying a second magnetic field aligned transversely, the alignment of the atomic nuclei (nuclear spin) changes for a short period. This change depends on the properties of the individual tissue. A suitable method of detection can then be used to visualize precise information about the tissue.
This method is also the least invasive for the human body, because the body is not exposed to harmful radiation as a result of X-rays, as is the case in computed tomography (CT).X-rays are used in this process in order to generate cross-sectional images of slices through human tissue. However, the X-ray source does not remain in the same place (as in the case with a conventional X-ray), but rotates about the body. If this rotation is carried out gradually in the longitudinal direction of the patient’s body, an image of the relevant region or indeed the entire body can be obtained by sections. A CT scan is particularly useful for gaining very detailed information about bone tissue.
Standard diagnostic tools also include procedures for measuring muscle and nerve activity. The methods used for this purpose are electromyography (EMG) and electroneurography (ENG) . Activities of muscles and nerves may be restricted or impaired in many diseases of muscles and nerves. Your neurologist can use these methods to find out the cause of this. Electromyography involves the measurement of tiny electric currents when activity occurs in muscles. A small electrode is inserted directly in the muscle through a cannula and then activated.
The electroneurogram is then derived by the acquisition system from surface electrodes. This data helps to determine and analyze speeds of conduction for nervous tissue. The nerve is also compromised in many degenerative diseases of the spinal column, for example as a result of a disk herniation or spinal canal stenosis, or the function of the nerve is constrained as a result of inflammatory changes. The neurogram is able to quantify function and impairment of the nerve and helps your physician to reach a decision on your future therapy.
The diagnostic process involves close contact between orthopedic specialists or neurosurgeons and radiologists and neurologists, and they will make their highly specialist contribution to the diagnosis and therapy of your disease.