Identifying the Source of Back and Neck Pain: Diagnostic Testing, Part 2

Minimally invasive spine surgery succeeds in large part due to the skill and experience of our surgeons in identifying the primary target in the spine responsible for the pain and selectively decompressing the nerve in that spot. Once the patient is evaluated and examined and the MRI is reviewed, the need for a diagnostic test will be considered.

Spine Treatment: More Than Meets the Eye

Conventional imaging studies such as an MRI, provide the foundation of the surgical order, however, often, the MRI shows abnormalities that are in fact asymptomatic.  Careful assessment of patients' symptoms and comparing them to the imaging study usually allow the surgeon to plan the operation only on necessary areas.  However, in some patients, the MRI is inconclusive in appearance. In those cases, selective pre-operative diagnostic injections are ordered.

 For patients with primarily neck or lower back pain, the MRI may not fully identify the exact area causing pain, as some spine conditions result from microscopic injury or disease.  In those cases, diagnostic injections can locate the areas of pain and allow surgery to be performed on the correct area based upon knowledge of those unseen, but now understood abnormalities.


Selective Nerve Root Block (SNRB)

For patients with the appearance of more than one area of nerve root compression, there may be a role for a selective nerve root injection.  In this test, the suspected nerve root is identified and then "blocked" using x-ray guided placement of an anesthetic agent (lidocaine) to determine what symptoms are resulting from that area of compression.  The immediate relief is reported in a percentage of reduction in pain and those results are then used to develop the final surgical order.  In cases, the results are negative or no relief and a second area may need testing.  In other cases, it may be determined that more than one area is involved and so may require additional surgery at a later date.

In part three, we will discuss additional diagnostic tests and explain what happens during these procedures.

Dr. Robert Gruber is the Director of Spinal Diagnostics and Therapeutics at Laser Spine Institute. Click here to learn more.