When to get a spinal X-ray for back pain

If you’ve turned to a physician for help with your back pain, it is likely that your pain has progressed to the point where it interferes with your daily life. It is your doctor’s top priority to first find the cause of your pain and other symptoms so that he or she can recommend an appropriate course of treatment that will help you reclaim your life from back pain. To do this, your physician will likely start by listening to you describe your medical history, conducting a physical exam and ordering any number of diagnostic tests.

A spinal X-ray may be recommended as part of the diagnostic process, as it is one of the most common imaging tests and can be used to diagnose a number of spine conditions. X-rays are simple, fast and painless outpatient imaging tests that can reveal several different problems within the spine. However, many back problems go away on their own, so depending on the severity of your pain and the amount of time your symptoms have been present, your physician may recommend that you delay diagnostic imaging and allow your body a bit of time to heal.

How do spinal X-rays work?

X-rays send powerful beams of energy called photons through the air and into the body. When these photons come into contact with different components of the body, they are absorbed in various amounts depending on the density of the tissues. For example, photons pass through soft tissues but are absorbed by dense tissues, such as bones. On an X-ray image, tissues that have not absorbed the radiation (muscles and ligaments, for instance) show up as black, while tissues that have absorbed the radiation show up as white. The images produced by X-rays are known as radiographs.

What can an X-ray diagnose?

Generally speaking, X-rays are used to capture images of a person’s organs and bones to diagnose a range of conditions and injuries. An X-ray for back pain may be useful if your physician suspects that you might have:

  • A fracture. A fracture is any loss of continuity in a bone. Some fractures are barely recognizable on an X-ray, such as a hairline fracture.
  • A broken bone. Similar to a fracture, a broken bone described a bone in the body that has lost its integrity.
  • Arthritis. Arthritis is a condition where a joint’s cartilage, which typically lines the joint and allows the bones to glide over one another painlessly, wears away, resulting in painful bone-on-bone contact.
  • Bone spurs. An X-ray can also detect bone spurs — or excess growths of bone — on the vertebrae.
  • Spondylolisthesis. This is a spine condition where one vertebra in the spine slips forward over the vertebra below it.
  • Degenerative disc disease. Also known as DDD, degenerative disc disease is the ongoing deterioration of the spine’s discs due to age-related changes in the spine.
  • Kyphosis. Kyphosis is an abnormal, exaggerated convex (forward) rounding of the spine. It can occur at any age but is most often found in older women.
  • Scoliosis. A sideways curvature of the spine that is most often found in children.
  • What spinal conditions can’t be seen with an X-ray?
  • X-rays are not capable of showing damage to nerves or other soft tissues, however. Some examples of conditions that an X-ray likely can’t diagnose include:
  • Pinched spinal nerve. A pinched nerve is a nerve that has become compressed by something else in the body, usually bone or a disc in the spine.
  • Ruptured disc. A ruptured disc is a spinal disc that has a tear in its outer layer (annulus fibrosus), allowing the gel-like inner core material (nuclear pulposus) to leak out of the disc and into the spinal column.
  • Bulging disc. A bulging disc has a weakened annulus fibrosus, so pressure from the nucleus pulposus causes the disc to protrude into the spinal column.
  • Sciatica. This term describes a set of symptoms that occur when the sciatic nerve, the longest nerve in the body that runs from the lower back down each leg, becomes compressed.

What are some other diagnostic tools besides an X-ray?

If your physician suspects you may have one of these conditions or another condition affecting the soft tissue, he or she might recommend a different diagnostic test, instead of an X-ray. For example, your physician may suggest a:

  • CT scan. Also called a computed tomography scan, a CT scan takes a series of images from different angles around the body and combines them to create cross-sectional images of the soft tissues, blood tissues and bones.
  • MRI. Magnetic resonance imaging uses magnets and radio waves to capture images of the body’s soft tissues.
  • Bone scan. A bone scan is a nuclear imaging procedure where tiny amounts of radioactive materials called tracers are injected into a vein. Areas of the body that are actively repairing themselves take up larger amounts of these tracers, alerting physicians to potential abnormalities in that area.
  • Diagnostic injection. A numbing agent is injected into a nerve or joint that a doctor suspects is the source of a patient’s pain. If the pain immediately subsides following the injection, the doctor has correctly identified the affected nerve or joint.

What happens during an X-ray?

To get X-rays taken, your doctor must order them, meaning you can’t simply walk into an imaging office and request an X-ray. Getting an X-ray taken is a quick and painless procedure that doesn’t take more than a few minutes. You will be given a lead sheet to cover the part of your body that is not being X-rayed to prevent unnecessary exposure to the radiation. Then, the X-ray technician will position you to get the best view of your neck or back, and you will need to remain as still as possible while he or she takes the image. It is likely that more than one image will be required, and you will likely need to shift positions a few times to capture the images from all necessary angles.

What happens after an X-ray for back pain?

Spinal X-rays are outpatient procedures, which means you’ll most likely be able to go home right after your test. Results can be available in as little as a few minutes with digital X-rays, although in some situations the images can take a few days to process and interpret. Your physician will reach out to you as soon as he or she has the results. You may be asked to come into your physician’s office to discuss your X-ray and any next steps for your treatment.

Conservative treatment for back pain

Once your physician has evaluated your diagnostic images, he or she can then determine the best approach to treatment. The specific type of treatment you will require will depend on a number of factors unique to you, including your individual spine condition, the severity of your pain and your overall health. That said, much of the time, treatment for a range of spine conditions begins with a combination of conservative methods. Conservative treatments aim to manage pain and other symptoms without addressing their underlying cause. For many patients, this will be sufficient in providing meaningful relief. Here are some examples of conservative treatment for back pain:

  • Over-the-counter or prescription medications
  • Low-impact exercises
  • Therapeutic injections
  • Physical therapy
  • Stretching
  • Hot/cold therapy

Alternative treatment for back pain

In addition to the methods mentioned above, you may also choose to explore alternative treatments on your own. Alternative treatments are not considered to be mainstream, but many patients have reported them successful in relieving their pain and other symptoms. Alternative treatments include chiropractic care, massage therapy, herbal supplements, acupuncture, Pilates and yoga.

It is important to check with your doctor before starting any alternative treatments on your own to be sure they won’t worsen your condition or interact with any other treatments you are using.

Surgery for back pain

Most likely, surgery will not be recommended in the initial stages of treatment — or perhaps even at all — depending on your body’s response to conservative care. Your physician can help you explore various options based on your specific diagnosis and other individual factors.

What to do if surgery is recommended

In the event that your physician does recommend surgery after several weeks or months of trying conservative treatment, be sure to fully explore the surgical options available to you so that you can make a fully informed decision about your spinal health. While traditional open spine surgery has been used for decades, there is an option that offers less risk of infection and complication.^ The minimally invasive outpatient procedures offered by Laser Spine Institute are performed by board-certified surgeons+ through less than 1-inch procedures using muscle-sparing techniques that result in shorter recovery times for our patients.^ For more information about our minimally invasive surgery, contact Laser Spine Institute today. We can provide you with a free MRI review* to determine if you are a candidate.