WHEN TO SEE A SPINE SPECIALIST

You should seek the advice of a spine specialist if neck or back pain persists for more than two weeks or if it is progressive in intensity and/or distribution. You should seek immediate healthcare attention if neck or back pain occurs as the result of an injury or if it is associated with serious illness and/or a high fever. Additional signs and symptoms which warrant prompt medical attention include:

• Neck or back pain associated with bowel and/or bladder dysfunction
• Neck or back pain associated with extremity weakness or difficulty with coordination
• Extremity numbness or muscle weakness
• Neck or back pain that is associated with impaired walking (gait) or difficulty with balance
• Numbness, tingling and/or muscle weakness associated with a back or neck injury

SCREENING AND DIAGNOSIS

The doctor may use a variety of approaches to diagnose foraminal stenosis and rule out contributing or complicating conditions.

• Medical history—the patient tells the doctor details about symptoms and about any injury, condition, or general health problem that might be causing the symptoms.
• Physical examination—the doctor (1) examines the patient to determine the extent of limitation of movement, (2) checks for pain or symptoms when the patient hyperextends the spine (bends backwards), and (3) checks for normal neurologic function (for instance, sensation, muscle strength, and reflexes) in the arms and legs.
• Nerve conduction studies/needle electromyography (EMG): Electrical testing of muscles and nerves is performed to determine whether there is nerve damage. This form of testing is used to assess the integrity of both spinal and peripheral nerves. It can also be sued to help identify whether a nerve is recovering as expected with therapeutic intervention.
• X ray—an x-ray beam is passed through the back to produce a two-dimensional picture. An x ray may be done before other tests to look for signs of an injury, tumor, or inherited problem. This test can show the structure of the vertebrae and the outlines of joints, and can detect calcification.
• MRI (magnetic resonance imaging)—energy from a powerful magnet (rather than x rays) produces signals that are detected by a scanner and analyzed by computer. This produces a series of cross-sectional images ("slices") and/or a three-dimensional view of parts of the back. An MRI is particularly sensitive for detecting damage or disease of soft tissues, such as the disks between vertebrae or ligaments. It shows the spinal cord, nerve roots, and surrounding spaces, as well as enlargement, degeneration, or tumors.