What film to take for back pain

When you have lower back pain, you need to go to the hospital for examination in time. Generally, after arriving at the hospital, the doctor will ask the patient to take films to make certain diagnoses. The films are mainly X-rays. The doctor can observe whether the patient has lumbar disc herniation, lumbar tuberculosis, or lumbar spinal stenosis and other conditions. Only through a good diagnosis can the next step of treatment and conditioning methods be determined.

1. 84% of people have experienced back pain.

Lumbar and back pain are very common. 84% of adults have experienced lumbago at some point in their lives. Most cases of lumbago are self-limiting diseases and do not require special treatment.

2. What are your low back pain symptoms?

Patients with low back pain should first pay attention to how the pain occurred, whether they have a history of sprain, whether the waist is exposed to cold or damp, etc. More importantly, don't be careless and go to the hospital for further examination if necessary.

After arriving at the hospital, you need to clarify the location and nature of the low back pain, whether it is pure low back pain or combined with radiating pain in the lower limbs (string pain), and whether it is accompanied by numbness in the lower limbs. Also pay attention to the relationship with walking. Do you experience lower limb soreness and fatigue after walking for a while and become unable to continue walking, but can continue walking after resting for a while (intermittent claudication)? Does you have a history of similar low back pain in the past?

The doctor will perform some necessary physical examinations based on the patient's description in order to find out the cause of the low back pain. If you suspect that you have lumbar disc herniation, lumbar spinal stenosis, lumbar tuberculosis or other problems, further examination is required.

3. Should we take a film?

Director Jia explained: "It is not necessary to perform imaging examinations within the first 4-6 weeks unless there are progressive neurological abnormalities or systemic diseases (such as spinal tumors and infections) are highly suspected. If there is no significant improvement in symptoms after 4-6 weeks, a plain lumbar spine X-ray is generally sufficient."

CT and magnetic resonance imaging (MRI) are more sensitive than plain x-rays for spinal infection, tumors, disk disease, and spinal stenosis, but > 50% of a disk bulge may be asymptomatic. Asymptomatic disc herniation is not uncommon. In comparison, disc herniation has greater diagnostic value. Indications for CT and magnetic resonance imaging (MRI) include progressive neurological dysfunction, high suspicion of spinal tumor or infection, and persistent back pain after 12 weeks.

4. Medical consultation + physical examination + X-ray can solve most problems.

Low back pain is very common, but in most cases, it can be relieved by proper rest or with medication, massage and other treatments. Only a few patients need further treatment, so an important role of clinicians is to use limited resources on suitable patients.

Imaging examinations are very important for diagnosing spinal diseases, but a balance must still be struck between necessity, cost, and radiation damage. Generally speaking, most problems of low back pain can be solved through doctor's interview and physical examination supplemented by X-ray examination.

5. CT and MRI are not necessarily better.

Director Jia emphasized: Although lumbar CT and MRI are more advanced in theory and are considered "better" examinations in the eyes of patients, in fact, plain X-rays can provide very good basic information and are more advantageous in reflecting spinal sequence. As a patient, you should get rid of the misconception that "expensive means good", listen to the doctor's advice, and choose reasonable examination items.

The radiation exposure of lumbar spine CT is much higher than that of X-ray. From the perspective of radiation exposure, lumbar spine CT > lumbar spine X-ray. Lumbar spine MRI has no radiation exposure, so from the perspective of reducing radiation damage, lumbar spine X-ray + MRI is a good combination.

Lumbar CT is better than MRI in showing bone lesions, and lumbar CT should also be referred to when making surgical plans (for example, CT is better than MRI in showing intervertebral disc calcification). It is recommended to use lumbar CT selectively.

6. There may be problems with the film, but that doesn’t necessarily mean there are real problems.

Director Jia reminds all patients that lumbar disc herniation shown in imaging does not mean lumbar disc herniation. More than 50% of lumbar disc herniation may not have any clinical symptoms, and there are also many cases of asymptomatic lumbar disc herniation.

Therefore, Jia Dong, director of the Fifth Department of Neurosurgery at Tangdu Hospital of the Fourth Military Medical University, kindly reminds you: Do not simply label a patient with "lumbar disc herniation" if you find a lumbar disc herniation on CT or MRI. You must go to a relevant specialist hospital for further examination based on symptoms and physical examination to make the above diagnosis.