When you seek medical
help after sustaining a neck or back injury in an accident, the physician
first takes a complete history. This includes the circumstances of your
accident, your general medical condition and your individual lifestyle,
including your symptoms, the location and severity of the pain, what home
treatments you have used, what kind of work you do, etc. A complete
physical exam follows. Afterwards, if the doctor cannot accurately
identify a specific type of back or neck injury, one of more of the
following diagnostic tests may be ordered:
- X-ray
- Computerized Axial Tomographic Scan (CT or CAT scan)
- Magnetic Resonance Imaging (MRI)
- Myelogram
- Discogram
- Electromyogram (EMG)
- Bone Scan
X-ray
X-rays are probably one of the best known diagnostic tests. X-rays are
generally indicated only for patients who have had pain for more than one
month or who have had a significant injury. Patients over the age of 60
should have x-rays at the onset of pain if there has been no injury.
During an X-ray, low doses of invisible electromagnetic energy with short
wavelengths pass through the body and cast a "shadow" photograph onto a
film or screen. Since bones are dense, they absorb X-rays well and show up
as white on the film, while the tissues show up darker.
One of the reasons X-rays are beneficial is that they can be performed
quickly. Since they highlight the bones, X-rays can be helpful in
uncovering an injury in a back bone, a tumor in the spine, or a spinal
deformity, but they are not effective in finding injuries to the soft
tissues. Still X-rays often help the physician determine what other tests
should be given.
During an X-ray test, you lie on a table, with the adjustable X-ray
machine above you. You won’t feel anything when the rays pass through your
body. The technician will ask you to remain still while the X ray is being
taken so that the image will not be blurred.
The exposure time during an X-ray is just a fraction of a second, and with
modern equipment, the radiation dose is very low. However, x-rays are
usually not performed if there is the possibility of pregnancy, and a lead
shield may be used to cover the patient’s reproductive organs from the
X-ray beam.
Computerized Axial Tomographic Scan (CT or CAT scan)
An important diagnostic tool, a CT scan combines X-rays with computer
technology, offering more information than plain X-rays. CT scans are
fast, safe and painless and may be combined with other tests, such as
myelograms and discograms (see page t/k), to achieve the most accurate
diagnosis possible.
During a CT scan, an X-ray beam passes through the body at various angles.
The machine uses a computer to detect the degree to which the tissues of
the body are absorbing the x-rays and then reconstructs an image. One of
the benefits of the CT scan is that gives a cross sectional look to the
spine, so the physician can essentially see inside the body to diagnose
the condition. The CT scan is helpful for detecting ruptured discs, spinal
stenosis, tumors and infections of the vertebra.
While receiving a CT scan, you’ll be lying on a table that moves you
slowly through the CT scanner--a large donut-shaped machine. The machine
passes a great number of thin X-ray beams, each of a low dosage and
lasting only a fraction of a second, through your body at different angles
as the scanner rotates around you. The test takes anywhere from 15 minutes
to an hour, and you can’t eat solid food for three hours prior to the
exam.
Although the CT scan is harmless, you are subjected to X-rays. So, again,
if there is the possibility of pregnancy, inform your physician.
Magnetic Resonance Imaging (MRI)
One of the most advanced diagnostic imaging methods available today, the
MRI provides a great deal of information about the human body and is often
used to evaluate the spine. Unlike plain X-rays, this noninvasive test not
only shows the physician the bones, but also provides excellent details of
the soft tissues. However, the MRI is not always the first test given
since it is more expensive and generally takes longer than the X-rays or
CT scans.
Instead of radiation, a MRI uses magnetic waves to take pictures of the
spine. A magnet excites the hydrogen atoms in the body, which give off
electromagnetic waves that are recorded by a computer. The computer then
analyzes the results to reconstruct an image of the spine.
The MRI scanner is a large tube with a table passing through it. Some
people worry about feeling closed in, however, the tube always remains
open on both ends. You won’t feel any pain, but you will hear some loud
noises during the exam. Depending on how many pictures are needed, the
exam can take anywhere from 20 minutes to 90 minutes.
It is very important that you notify your physician if you have any metal
in your body which cannot be removed, such as a pacemaker, aneurysm clips
or a prosthesis. You may not be able to have an MRI if you have such metal
in your body. Leave your jewelry at home, and remove all metallic objects
such as hearing aids and dentures before entering the scanning room.
Myelogram
A myelogram is more invasive than a MRI but may be necessary sometimes to
better diagnose the patient’s condition. A CT scan is often performed at
the same time as the myelogram in order to gather even more information.
During a myelogram, special dye that shows up on X-rays is placed into the
spinal sac. If there is any decrease or blockage in the flow of the
cerebral spinal fluid around your spinal column, it may mean there is
pressure on the nerves of the spine, possibly from a herniated disc or
bony spur, or, less often, a tumor.
While you lie on a X-ray table, you are given a local anesthetic to numb
the area. A needle is placed into the area near your spine, dye is
injected and then the X-rays are taken. The test will take about an hour
to complete. Afterwards, you may be taken for a CT scan, which can offer
some additional information that the myelogram may not find. For example,
if a piece of disc has broken off and is pressing on a nerve somewhere
other than its root, a CT-scan may detect it while the myelogram may not.
You won’t be able to eat solid foods after midnight the night before your
test, but please drink plenty of fluids such as water, tea and juice in
order to be well hydrated. Just stop drinking fluids three hours
beforehand. Ask your physician about any medications you are taking. After
your myelogram, you will need plenty of rest, and you cannot drive
yourself home.
Your radiologist will discuss the risks of the myelogram, which are very
small but include itching around the puncture site, infection and allergic
reactions. You may develop a headache either several hours or several days
after the test. This is usually caused by a change in the pressure of the
cerebral spinal fluid and should be cured with rest and plenty of fluids.
Discogram
The discogram is similar to the myelogram in that special dye is injected
and X-rays are taken. It is also often accompanied by a CT scan. However,
the dye is injected into the spine’s discs rather than the spinal sac.
While discs don’t show up on ordinary X-rays, the X-rays of the dye may be
able to show if a disc has ruptured since any leakage of dye will be
revealed. Also, any sensation of pain from the injection may indicate that
a particular disc is the source of the patient’s pain.
During the test, you will be hooked up to an IV to sedate you if necessary
and protect against any allergic reaction. While you’re lying face down on
the table, needles are injected into the selected discs, iodine dye is
injected and X-ray pictures are taken. The procedure takes about 20
minutes and may be uncomfortable. Then you may be sent for a CT scan to
give your physician even more information.
Don’t eat after midnight the day of your exam, and ask your physician if
you should take your regular medications. The dye will be removed from the
body through the flow of urine a few hours after the procedure. You will
not be able to drive home because of the sedatives. You will need to rest
at least overnight after the procedure.
Electromyogram (EMG)
The EMG studies the condition of the nerve roots leaving the spine by
examining the electrical activity in the muscles which these nerve roots
control. For example, if you are feeling lower back pain, your leg muscles
may be tested to see if there is a problem with the nerves that travel to
your lower extremities.
During an EMG, tiny electrode needles are inserted into the muscles being
tested. The electrical activity of the muscles is examined during both
contraction and rest, and the electrical activity in the muscle is
amplified, displayed and recorded for analysis. If the muscle is not
functioning normally, it may mean that a nerve is being irritated or
pinched--perhaps a sign of a herniated disc or spinal stenosis.
The test takes anywhere from 30 minutes to an hour, depending on the
number of muscles being tested. The EMG is safe, although the needles may
cause bruising.
Bone Scan
A bone scan is a type of radionuclide imaging that can help a physician
locate the affected area of the spine. It can help evaluate spinal tumors,
infection or occult fractures more accurately than plain X-rays.
During a bone scan, a radioactive chemical is injected into the
bloodstream. This chemical adheres to parts of the bone which are
undergoing rapid changes. After a gamma camera scans the area, these parts
show up as dark areas on the film. Once the physician has identified the
affected area of the spine, other tests may be given to look at the area
more closely.
The bone scan is safe since the levels of radiation in the chemical are
very low--even lower than the levels one is exposed to during plain
X-rays.
No lawyer can tell you at the beginning of your claim how much your case
is worth until he or she has all the medical records, bills and wage loss
analysis in hand. However, by calling
800-437-2571 anytime and
explaining the specific circumstances of your accident and injuries, one
of our experienced personal injury attorneys, may be able to give you a
“ball park figure,” or if you prefer, may also use our convenient
Free Case Evaluation
submission form.
