The various diagnostic (imaging) methods available today, make it possible for us to obtain a score of information - without so much as touching the skin with a needle - regarding the body's condition or the stage an illness is in. These methods are the non-invasive methods which include, for instance, ultrasonography (US), thermography, isotope, computer tomography (CT) and magnetic resonance imaging (MRI).
Some of the listed methods (i.e., US) cannot be used successfully in spine care while others (i.e., thermography) have not yet been scientifically accepted. The others listed are diagnostic methods that may be widely and effectively used, however, the information gained is limited and, in certain instances, insufficient. Their disadvantage is that the images are static, can only be taken in a prone position (the body is not weight bearing) and make it often impossible to find the source of pain even when analyzed together with a thorough physical examination. Here, then, enter then the minimally-invasive diagnostic methods - myelography and discography.
Myelography is a type of radiographic examination wherein an iodine contrast material is injected into the cerebrospinal fluid located in an enclosed space surrounded by the dural sac. This method allows us to find any imprint or deformity on the dural sac that might be negatively impacting the nerves running down from the dural sac and be the source of pain we are looking for.
Since similar information is obtainable more safely with the CT and MRI, this method has, to a great degree, been pushed aside especially since the Patient must rest for a few hours after the intervention, may suffer serious headaches and, though rarely, develop an allergic reaction.
There are cases, though, when information obtained through the methods listed above is not sufficient. One of these would be, for instance, the case where the area to be examined is a previously operated spine segment containing metal implants. If the metal used is magnetizable, the MRI cannot not be used and, due to the disturbing signals emitted, the quality of the CT images is weak. Unfortunately, the non-magnetizable metals also influence image quality, all the more so, the more metal is present. In these cases, myelography may provide the surgeon valuable additional information.
The most vulnerable and one of the most often injured elements of the spine's three functions (support, protection and motion) is the disc. The condition of the disc and the role it plays in a Patient's pain can, fortunately, often be successfully evaluated through the combination of a thorough physical examination and a suitable imaging technique. The method used is decided by the Patient's complaints and medical history. In cases where several discs appear to be injured, additional information may be required.
Discography helps, partly, in finding the source of pain and, partly, in determining the degree of degeneration. A contrast material is injected into the center of the disc, coloring the core. If the procedure does not cause obviously identifiable pain to the Patient, then the disc, irrespective of its condition, is not a target for surgery. If the pain felt earlier is reproduced, the disc might then be targeted for surgery with the surgeon's decision dictated by the disc's morphology as to the correct surgical intervention. In cases of advanced degeneration or serious injury to the disc, conventional surgical techniques are used while, in beginning degeneration cases or cases where the structure is still relatively intact, various percutaneous techniques may be used.
Therapy and Diagnostics in one Step
Locally administered anti-inflammatory injections have been successfully used in musculoskeletal surgery (orthopedics) in the treatment of joint, tendon and other inflammatory conditions. These injections contain two components, a local anesthetic and a steroid anti-inflammatory medication. The former has an almost immediate short-term effect, verifying that the medication was injected into the proper place, thus helping the diagnostic process. If the steroid component of the injection reaches its pain relieving effect two-three days later, it is of further diagnostic and therapeutic value, as well.
The Nerve Root Block: injection of medication into the segmental exiting nerve root in the area of the neuroforamen, or laterally from there. Generally, the Patient may go home immediately thereafter.
Facet Joint Block: medication is injected into the spine's sinovial joint or joints. The Patient may go home immediately thereafter.
Epidural Block or Sacral Epidural Adhesiolysis (SEA): medication is injected into the epidural space - may be effective in controlling lumbar irradiating pain. The Patient may, generally, return home after resting one-two hours.