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 first step to assessing for possible myelopathy is the personal history and physical examination. The correlation of these tow methods is very effective at determining whether there is or may be myelopathy. These methods are also very effective at localizing the level of spinal cord involvement although less effective for determining the cause of myelopathy. During the diagnostic workup nerve studies (electrodiagnostic studies) may be performed to help rule out other neurological causes for the presentation and to help confirm the presence of myelopathy and/or radiculopathy.

When myelopathy is confirmed or suspected the next step is to obtain diagnostic imaging of the region. The usually involves plain spinal X-rays.  Plain radiographs may depict bone spurs (osteophytes) and/or other degenerative changes associated with narrowing of the spinal canal (spinal stenosis). X-rays may also reveal bone destruction secondary to an aggressive tumor. Computerized tomography (CT) improves the depiction of both bony encroachment on the spinal canal and compression of the spinal cord by herniated disc material that not able to be seen on plain X-rays. Bone destruction and soft tissue masses are also better seen.

MRI is by far the single most effective diagnostic imaging methods for assessing the spinal cord. MRI has largely replaced CT scanning in the noninvasive evaluation of patients with painful myelopathy because of its superior ability to image soft tissues and the ability to view the spine and spinal cord from so many angles (multiplanar capability) Invasive evaluation with myelography and CT myelography may be utilized when visualization of the spinal cord and related nerve structures is required for surgical planning or other specific problem solving. MRI is very valuable for detecting spinal cord compression which may be subtle. It can depict swelling, bleeding and scar tissue within the spinal cord. The MRI may be performed with and without the use of contrast to improve the likelihood of detecting and characterizing certain types of spinal cord problems.