What to Expect from Your Spine Imaging Appointment

Prepare for your spine X-ray, MRI, or CT scan with these insights from our expert spine surgeon.

Sometimes—often, even—there’s no obvious cause of back pain. You’ve described your symptoms. You’ve undergone some tests. But your pain continues to be a head-scratcher. That’s where imaging comes in, the next best thing to Superman’s X-ray vision. And it’s very commonplace—interestingly, according to the United States Nuclear Regulatory Commission, medical procedures make up nearly all human exposure to man-made radiation—specifically, 96%.

Woman in MRI machine for spine imagingImaging, the next best thing to Superman's X-ray vision.

There are some back pain issues that can benefit from or even require an imaging appointment. According to SpineUniverse Editorial Board member and orthopedic surgeon Dwight S. Tyndall, MD of Chesterton, Indiana’s Lakeshore Bone & Joint Institute, back pain that’s due to trauma, has lingered more than four to six weeks, or is accompanied with a history of cancer, fevers, or night sweats warrants imaging.

It’s common for doctors to turn to imaging when diagnosing a spinal condition. But what can you expect from your appointment? Dr. Tyndall is here to provide insight into these appointments.

X-ray for Back Pain

When you were young, perhaps you remember getting an X-ray after falling off your bike. Today, a back pain X-ray can prove to be just as helpful for you and your spine.

“An X-ray is a radiation-based study which is used to examine the conditions of bone or bony structures,” Dr. Tyndall says. “X-rays are best for bony tissue or any tissue that is ossified or calcified.” In other words, X-rays are adept at showing hard tissue such as bones, but not so much soft tissue like muscles, ligaments, or intravertebral discs.

Doctor looking at spine X-raysX-rays are adept at showing bone and other hard tissue.

If you’re undergoing a lower back X-ray, you’ll be scanned by a machine which generates an x-ray beam. It also has a receiver that picks up the beam after it has passed through the body, thus generating an image. Typically, X-ray imaging takes around five minutes to complete, but it could take longer depending on how many images your doctor needs.

Often, X-ray imaging serves as a precursor to another form of imaging you may eventually need. This can be helpful for insurance purposes, and also to rule out bone conditions such as compression fractures or bone spurs.

You may have heard that an X-ray can be done in an impromptu manner at an initial orthopedic appointment, foregoing the need for a separate appointment. Dr. Tyndall says that this usually isn’t the case.

He says, “X-rays are ordered for specific reasons and are not done impromptu. X-rays are usually a part of the diagnostic studies which are ordered—this will include an MRI and/or CT scan.”

CT Scan for Back Pain

A CT scan, which stands for “computed tomography,” is a series of X-rays which are then complied into images using a computer. Think of it as typical X-ray imaging with a bit more kick.

“The advantage of a CT scan over a standard X-ray is that it allows views of a body part from many different angles and can include 3D-like images,” Dr. Tyndall says. He adds that CT scans are most often used in trauma situations or for patients who have had previous surgery, and they’re “relatively quick,” taking only around five minutes.

There’s also another key difference between X-ray imaging and a CT scan. For an X-ray, you’ll stand up or lay prone under the X-ray machine as it scans your body. A CT scan will require you to lie down as your body is scanned by a circular, tunnel-like machine that rotates throughout the imaging.

X-ray imaging and CT scans do share one similarity: Dr. Tyndall says that for both appointments, patients can wear “normal, casual attire.”

There’s also contrast dye to consider. Used during all types of imaging appointments, Dr. Tyndall says that dye, or intravenous contrast, is used to generate sharper images by allowing more vascular tissues to stand out. Contrast dye could potentially help a doctor as they arrive at a diagnosis.

People generally report feeling the dye as it’s injected. As Dr. Tyndall says, “Some patients report that it feels like a warm feeling as the dye is injected.”

MRI for Back Pain

An MRI—short for “magnetic resonance imaging”—is another powerful form of imaging. Unlike a CT scan or X-ray, a major advantage of an MRI is that it’s not based on radiation, but instead, uses magnets to generate images. You can keep this in mind if you’re concerned about radiation exposure.

Spine imaging MRIYour providers can help you feel more comfortable during your MRI, especially if you tell them you're claustrophobic.

Dr. Tyndall says that MRI imaging is “often used in patients who have had previous surgery” and they take longer than other imaging appointments, usually around 30 to 45 minutes.

Although you can dress normally for an MRI, Dr. Tyndall says that since no metallic objects are allowed in the MRI, patients need to remove items like belts, jewelry, etc.

Contrast dye can be a part of MRI imaging, and the machine is encased in a tunnel, which can get a bit nerve-wracking if you’re prone to claustrophobia. Be sure to speak with your doctor and find out how you can feel more comfortable during the appointment.

For his patients who are claustrophobic, Dr. Tyndall recommends an anti-anxiety medication such as Valium. He adds, “Taking an anti-anxiety medication is a great way to go during an MRI if the patient is uncomfortable in small spaces.”

Patients typically don’t experience high anxiety during X-rays and CT scans—Dr. Tyndall notes that when compared to an MRI, a CT scan is “much quicker” and the scan itself “is very roomy, so most patients do not have an issue with claustrophobia.”

An MRI vs. X-ray for back pain holds the same differences between a CT scan vs. MRI for back pain. While X-ray imaging uses radiation, an MRI utilizes magnets.

Other Forms of Imaging

Beyond X-rays, CT scans, and MRIs, there are a few other forms of imaging to be aware of:

  • Fluoroscopy
  • CT navigation
  • Ultrasound

Fluoroscopy imaging involves an X-ray beam that’s passed directly through the body resulting in live, moving images. CT navigation provides a real-time CT scan during a procedure.

“Both of these types of imaging are used during surgery to increase accuracy and to limit the size of the incision,” Dr. Tyndall notes, adding that intra-op imaging, as it’s called, involves high-tech robotics that provide navigation to surgeons like never before.

Lastly, you’re likely familiar with ultrasounds being used to view developing babies, and occasionally, they can be used for spinal conditions.

“An ultrasound is an imaging test that uses sound waves to create an image,” Dr. Tyndall explains. “It is not used in spinal imaging often. The imaging tests which are used in spinal imaging are primarily X-rays and MRIs.”

Your Imaging Appointment

As with any medical appointment, it can help to speak with your doctor ahead of time to learn more about what to expect as you undergo imaging. Find out how to prepare and if there are any special instructions for you to carry out before your appointment.

“Imaging is an important part of any spinal evaluation, along with the history-taking and the physical exam,” Dr. Tyndall says. “By putting these three things together, the clinician is able to arrive at a diagnosis.”

Updated on: 08/02/21
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