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Non-Radiographic Axial Spondyloarthritis: El Paso Back Clinic

Non-Radiographic Axial Spondyloarthritis: El Paso Back Clinic

Non-radiographic axial spondyloarthritis or nr-axSpA and non-radiographic ankylosing spondylitis/AS are related. However, non-radiographic axial spondyloarthritis can present AS symptoms with active inflammation of the spine and sacroiliac/SI joints, causing back and hip pain but does not reveal joint damage on X-rays or MRIs. Injury Medical Chiropractic and Functional Medicine Clinic can explain what it means to have non-radiographic axial spondyloarthritis, how it can be managed, and what to do to prevent it from turning into ankylosing spondylitis.Non-Radiographic Axial Spondyloarthritis: EPs Chiropractic Team

Non-Radiographic Axial Spondyloarthritis

Non-radiographic axial spondyloarthritis means there are early AS symptoms but have not developed enough joint inflammation or damage to show up on an X-ray or other form of imaging. Early evidence of joint inflammation includes blurring of the joint edges and localized regions of joint erosion. It can be difficult for physicians to see these subtle changes on an x-ray.

Ankylosing Spondylitis

  • Ankylosing spondylitis, or AS, is a form of inflammatory arthritis that affects joints in the spine and elsewhere.
  • It is a chronic, inflammatory, autoimmune disease.
  • Medical research is still ongoing to determine the exact cause, but a genetic component is believed to be contributing factor.
  • Around 85% of individuals with ankylosing spondylitis have inherited the HLA-B27 gene, which is associated with multiple autoimmune conditions.
  • In the early stages, individuals will present lower back pain around the sacroiliac joints or the joints that connect the spine to the pelvis.
  • Later stages have more obvious X-ray findings, like the fusing of the sacroiliac joints and the lower spine that takes place over time.
  • Joint inflammation can progress, causing permanent joint damage and spine rigidity.
  • Most individuals with the condition can manage their symptoms with NSAIDs, chiropractic care, physical and massage therapy, and range of motion exercises.

Stage 1

  • There is no evidence of spinal inflammation on x-rays.
  • MRI provides more detailed images of bones and may reveal bone marrow edema or accumulation of fluid in the structures of the spinal bones and joints.
  • Individuals with non-radiographic axial spondyloarthritis, you are here.

Stage 2

  • There is visible inflammation of the spinal joints on the x-ray.
  • The sacroiliac joints between the spine and the pelvis are the most affected.

Stage 3

  • Chronic inflammation of the joints has caused bone loss and permanent joint damage, resulting in spine rigidity.

Symptoms of Non-Radiographic Axial Spondyloarthritis

There are differences between back pain associated with muscle strain and arthritis. Back pain symptoms include:

  • Starts to present before age 40.
  • It has a gradual onset and can go unnoticed for years.
  • Improves with movement or activity.
  • Eases up throughout the day.
  • Starts up in the evening when resting.

Other symptoms include:

  • Joint stiffness
  • Swollen fingers
  • Heel pain
  • Bilateral buttock discomfort and pain

Slowing Progression

Progression from non-radiographic axial spondyloarthritis to ankylosing spondylitis occurs in 10% – 20% of individuals over a two-year period. Progression factors include genetics, gender, degree of joint damage, and level of inflammatory markers at the time of diagnosis.

  • Early diagnosis and treatment can slow the progression before significant joint damage with anti-inflammatory therapy, rheumatological therapy, and targeted exercise.
  • Work with a specialist like an orthopedic spine specialist and rheumatologist that understands the disorder and is up to date on the most recent treatment modalities.
  • A rheumatologist will perform diagnostic tests, including spine X-rays, genetic blood work, and serum inflammatory markers.
  • Individuals with non-radiographic axial spondyloarthritis should expect to have serial X-rays to gauge the progression of the disease.
  • Staying healthy and active is recommended to slow the progression of nr-AxSpA and AS.
  • Recent medical advances and lifestyle adjustments can slow the progression in most cases.

axSpA


References

Six tips for living well with ankylosing spondylitis. Available at www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/in-depth/6-tips-for-living-well-with-ankylosing-spondylitis/art-20478753. Accessed 11/07/2022.

Ankylosing spondylitis. Mayo Clinic. Available at www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/symptoms-causes/syc-20354808. Accessed 11/05/2022.

D. J. Pradeep, A. Keat, K. Gaffney, Predicting outcome in ankylosing spondylitis, Rheumatology, Volume 47, Issue 7, July 2008, Pages 942–945, doi.org/10.1093/rheumatology/ken195

Kucybała, Iwona, et al. “Radiologic approach to axial spondyloarthritis: where are we now and where are we heading?.” Rheumatology international vol. 38,10 (2018): 1753-1762. doi:10.1007/s00296-018-4130-1

Michelena, Xabier, López-Medina, Clementina, and Helena Marzo-Ortega. “Non-radiographic versus radiographic axSpA: what’s in a name?”.” National Center for Biotechnology Information. October 14, 2020. doi.org/10.1093/rheumatology/keaa422

Swift D. Ankylosing spondylitis: disease progression varies widely. Medpage Today. Accessed 11/05/2022.Available at www.medpagetoday.com/rheumatology/arthritis/49096

Spinal Stenosis MRI: Back Clinic Chiropractor

Spinal Stenosis MRI: Back Clinic Chiropractor

Spinal stenosis is when space somewhere along or within the spine begins to narrow, closing off the ability of normal/comfortable movement and nerve circulation. It can affect different areas, including the cervical/neck, lumbar/low back, and, less commonly, the thoracic/upper or mid-back regions causing tingling, numbness, cramping, pain, muscle weakness, or a combination in the back, leg/s, thighs, and buttocks. There can be various factors causing the stenosis; correct diagnosing is the first step, and where a spinal stenosis MRI comes in.

Spinal Stenosis MRI: Injury Medical Chiropractor

Spinal Stenosis MRI

Stenosis can be challenging to diagnose as it is more of a symptom/complication than a condition, often caused by herniated discs, bone spurs, a congenital condition, post-surgery, or after an infection. Magnetic resonance imaging/MRI is a common test used in diagnosis.

Diagnosis

  • A healthcare professional, like a chiropractor, physical therapist, spine specialist, or physician, will begin with understanding symptoms and medical history.
  • A physical exam will be conducted to learn more about the location, duration, positions, or activities that decrease or worsen the symptoms.
  • Additional tests include muscle strength, gain analysis, and balance testing to help better understand where the pain is coming from.
  • To confirm a diagnosis, imaging will be required to see what is going on.
  • An MRI uses computer-generated imaging to produce images that show bone and soft tissues, like muscles, nerves, and tendons, and if they are compressed or irritated.
  • A healthcare professional and MRI technician will go over the safety requirements before the imaging.
  • Because the machine uses powerful magnets, there can be no metal on or in the body, like implanted prostheses or devices that include:
  • Pacemakers
  • Cochlear implants
  • Medication infusion pumps
  • Intrauterine contraceptives
  • Neurostimulators
  • Intracranial aneurysm clips
  • Bone-growth stimulators
  • A different imaging test may be used if an individual cannot have an MRI like a CT scan.

An MRI can range from several minutes to an hour or longer, depending on how many positions are necessary to isolate the injured area and get a clear image. The test is painless, but sometimes individuals are asked to maintain a specific position that could be uncomfortable. The technician/s will ask if there is discomfort and offer any help to make the experience as easy as possible.

Treatment

Not all cases of stenosis cause symptoms, but there are treatment options that a healthcare professional can recommend.

  • Conservative care is the first recommendation that includes chiropractic, decompression, traction, and physical therapy.
  • Treatment increases muscle strength, improves range of motion, improves posture and balance, decreases discomfort symptoms, and incorporates strategies to prevent and manage symptoms.
  • Prescription medications could be part of a larger treatment plan.
  • Surgery could become an option in more severe cases where conservative care is not working.

Spinal Stenosis


References

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Diagnosis of lumbar spinal stenosis: an updated systematic review of the accuracy of diagnostic tests. 2013. Available from: www.ncbi.nlm.nih.gov/books/NBK142906/

Ghadimi M, Sapra A. Magnetic Resonance Imaging Contraindications. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK551669/

Gofur EM, Singh P. Anatomy, Back, Vertebral Canal Blood Supply. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK541083/

Lurie, Jon, and Christy Tomkins-Lane. “Management of lumbar spinal stenosis.” BMJ (Clinical research ed.) vol. 352 h6234. 4 Jan. 2016, doi:10.1136/bmj.h6234

Stuber, Kent, et al. “Chiropractic treatment of lumbar spinal stenosis: a review of the literature.” Journal of chiropractic medicine vol. 8,2 (2009): 77-85. doi:10.1016/j.jcm.2009.02.001

Spinal Imaging Back Pain Clinic Expectations

Spinal Imaging Back Pain Clinic Expectations

Chiropractors and spine specialists utilize spinal imaging through X-rays, MRIs, or CT scans to figure out what is causing back problems and pain. Imaging is common. Whether chiropractic or spinal surgery, they help immensely discover back issues and allow the individual to see what is happening. Types of cases include back pain that:

  • Comes from trauma
  • Has lingered for four to six weeks
  • It is accompanied by a history of:
  • Cancer
  • Fever
  • Night sweats

Doctors use these images when diagnosing a spinal condition. Here is some insight into spinal imaging.

 

Spinal Imaging Back Pain Clinic Expectations

X-rays

X-rays for back pain can be quite helpful. An X-ray is radiation-based and is used to examine the conditions of the bone structures. X-rays are optimal for bone tissue or tissues that are ossified or calcified. They work the best with hard tissues, specifically bones. Soft tissues like muscles, ligaments, or intravertebral discs do not present as well.

Individuals undergoing a back X-ray will be scanned by a machine that generates a beam. A receiver picks registers the beam after it passes through the body and generates an image. It takes around five minutes to complete but could be longer depending on the doctor’s number of images. X-rays are helpful for insurance purposes and rule out bone conditions like compression fractures and/or bone spurs. X-rays are ordered for specific reasons and are often part of a whole-body diagnostic study. This includes MRI and/or CT scan.

CT Scan

CT stands for computed tomography. It is a series of X-rays that are digitized into images using a computer. The advantage of a CT scan to standard X-rays is that it offers different views/angles of the body and can be in 3D. CT scans are most often used in trauma cases or individuals who have had surgery. They take around five minutes. For X-rays, individuals stand up or lay under the X-ray machine as it scans the body. A CT scan has the individual lie down in a circular donut-looking machine that scans while rotating during the imaging. Individuals are recommended to wear casual loose, comfortable clothing. Sometimes a dye, or intravenous contrast, is used to get the vascular tissues to stand out, generating clearer images.

MRI

MRI is short for magnetic resonance imaging. MRIs use magnets to generate images. MRI imaging is often used in individuals that have undergone surgery. They take longer, usually around 30 to 45 minutes. No metallic objects are allowed in the MRI. Patients are asked to remove items like belts, jewelry, etc. Contrast dye can be a part of an MRI. The machine is like a tunnel. This can become challenging for individuals that have claustrophobia. Consult with a doctor and find out how to get comfortable during the process.

Other Forms of Spinal Imaging

Other forms of imaging include:

CT navigation

  • CT navigation shows real-time CT scans during the procedure.

Fluoroscopy

  • Fluoroscopy involves an X-ray beam that passes directly through the body that shows live, moving images.

Both of these types of spinal imaging are utilized during surgeries. For some cases, intraoperative imaging is used. This type of imaging uses high-tech robotics to help surgeons navigate through tight spaces during the procedure. This increases the surgeon’s accuracy and reduces the size of the incision.

Ultrasound

Ultrasound can be used for spinal conditions. This is an imaging test that uses sound waves to generate images. However, the imaging tests which are used in spinal imaging are primarily X-rays and MRIs.

Imaging Appointment

Talk with your doctor or chiropractor ahead of time to understand what to expect during the imaging process. They will let you know how to prepare and any special instructions before the appointment. Along with medical history and a physical examination, spinal imaging is an important part of the diagnostic process to find what is causing the pain and to develop the best treatment plan.


Body Composition


Short-term Effects of Coffee and Blood Pressure

The caffeine in coffee is a stimulant or substance that excites the body’s systems. When caffeine is ingested, individuals experience an increase in excitement, specifically in the cardiovascular system. This excitement causes the heart rate and blood pressure to rise and then lower back to a baseline level for healthy individuals. Coffee slightly increases short-term blood pressure. Moderate coffee consumption is safe for individuals that do not have pre-existing cardiovascular conditions.

References

United States Nuclear Regulatory Commission. (May 2021) “Doses in Our Daily Lives” www.nrc.gov/about-nrc/radiation/around-us/doses-daily-lives.html

X-Ray for Back Pain: Current Reviews in Musculoskeletal Medicine. (April 2009) “What is the role of imaging in acute low back pain?” www.ncbi.nlm.nih.gov/pmc/articles/PMC2697333/

Why Do I Need an X-ray or MRI for Lower Back Pain El Paso, TX?

Why Do I Need an X-ray or MRI for Lower Back Pain El Paso, TX?

Low back pain is one of the most common ailments for people visiting a doctor or an urgent care clinic. When the back pain becomes intense, it can get you thinking something is seriously wrong with your back. The doctor might offer an x-ray or MRI scan to put your concerns at ease.

Fortunately, most cases of low back pain, even acute pain, improve within days or a few weeks. Most cases are remedied with chiropractic, physical therapy, heat/ice therapy, and rest. And a lot of these cases do not require any form of spinal imaging. However, those are why X-ray, MRI, and CT scans are necessary to figure out what’s happening.

  • Strained muscle
  • Sprained ligament
  • Poor posture

These typical causes of low back pain can be painful and limit activities.

 

11860 Vista Del Sol, Ste. 128 Why Do I Need an X-ray or MRI for Lower Back Pain El Paso, TX?

 

Back Pain Lasting Longer Than 2/3 Weeks

Subacute pain lasts between 4 and 12 weeks, while chronic back pain lasts three months or longer. These are not indications of a severe lower back spinal condition.

Less than 1% of people with low back pain are diagnosed with the condition that may require spine surgery:

 

X-rays or MRIs for Diagnosing Low Back Pain

Doctors may recommend an x-ray or MRI if the low back pain is from a traumatic injury, like a:

  • Slip
  • Fall
  • Automobile accident

Other potential causes of low back pain may warrant medical imaging immediately or later.

The diagnostic process starts with the evaluation of the low back symptoms and how they relate to what was found during the:

  • Physical exam
  • Neurological exam
  • Medical history

A doctor utilizes these results to determine whether spinal imaging is necessary, along with the type of imaging test, x-ray, or MRI and the timing to confirm a diagnosis.

A Low Back X-Ray/MRI

X-ray spinal imaging best detects bony structural problems but is not so great with soft tissue injuries. X-ray series may be performed to diagnose vertebral compression fractures.

  • Anterior
  • Posterior
  • Lateral views

MRI is a radiation-free test. MRIs create 3-D anatomical views of the spinal bones and soft tissues. A contrast dye like gadolinium is used to enhance and improve the quality of the images. The contrast is injected through an intravenous line in your hand or arm before or during the test. An MRI can evaluate neurological symptoms, like radiating pain or pain that develops after a cancer diagnosis.

Symptoms, Co-existing Medical Diagnoses, and Conditions that may Require Spine Imaging

Neurological symptoms

  • Low back pain that radiates, fans out, or downward into the buttocks, legs, and feet
  • Abnormal reflexes in the lower body can indicate nerve disruption
  • Numbness, tingling, and possibly weakness develop
  • Inability to lift your foot, aka foot drop

Co-existing medical diagnoses and conditions

  • Cancer
  • Diabetes
  • Fever
  • Osteoporosis
  • Previous spinal fracture
  • Spine surgery
  • Recent infection
  • Immunosuppressant medication use
  • Corticosteroid medication
  • Weight loss

 

X-ray Radiation Exposure

Radiation to your entire body is measured through the millisievert (mSv), also known as the effective dose. The radiation dose is the same amount every time you experience an x-ray. When undergoing an x-ray, the radiation not absorbed by the body creates the image.

The effective dose helps a doctor measure the risk for possible side effects of radiographic imaging:

  • CT scans use radiation as well
  • Specific body tissues and organs in the lower back are sensitive to radiation exposure, like the reproductive organs.

 

MRI Radiation-Free Why Not Just Use This Test All The Time

MRI cannot be used on all patients because of its powerful magnet technology. Pregnant women or individuals with metal inside their body, like a spinal cord stimulator, heart pacemaker, etc., cannot be scanned with an MRI.

MRI testing is also expensive; doctors do not want to prescribe unnecessary tests that increase costs. Or because of the fine detail that MRIs provide, sometimes a spinal issue can look severe but is not.

Example: An MRI of the lower back reveals a herniated disc in a patient with no back/leg pain or other symptoms.

This is why doctors bring all their findings like the symptoms, physical exam, and medical history to confirm a diagnosis and create a custom treatment plan.

Imaging Test Takeaways

If low back pain takes its toll, listen to what the doctor recommends. They might not order a lumbar x-ray or MRI immediately but remember the issues mentioned above, like neurological symptoms and co-existing medical conditions. But these tests help discover the cause or causes of the pain. Remember this is to help get patients to their optimal health and pain-free.


 

How to eliminate Back Pain naturally | (2020) Foot Levelers |El Paso, Tx

 


 

NCBI Resources

Imaging diagnostics is an essential element in the evaluation of spine trauma. The rapid evolution of imaging technology has tremendously changed the assessment and treatment of spine injuries. Imaging diagnostics utilizing CT and MRI, among others, are helpful in acute and chronic settings. Spinal cord and soft-tissue injuries are best evaluated by magnetic resonance imaging, or MRI, whereas computed tomography scanning or CT scans best evaluate spinal trauma or spine fracture.

 

 

Diagnostic Outpatient Imaging

Diagnostic Outpatient Imaging

Dr. Alex Jimenez collaborates with top rated diagnosticians and imaging specialists. We are blessed to have in our association, imaging specialists that provide fast, courteous & premiere board certified specialists. In collaboration with our offices we can provide the quality of service our patients mandate and deserve.

Who We Are

Diagnostic Outpatient Imaging (DOI) is a state-of-the-art Radiology center in El Paso, TX. It is the only center of its kind in El Paso, owned and operated by a Radiologist.

This means when you come to DOI for a radiologic exam, every detail, from the design of the rooms, the choice of the equipment, the hand-picked technologists, and the software which runs the office, is carefully chosen or designed by the Radiologist and not by an accountant.

Our market niche is one center of excellence. Our values related to patient care are: We believe in treating patients the way we would treat our family and we will do our best to ensure that you have a good experience at our clinic.

Dear Doctors,

We are pleased to inform you of the arrival of our Titan 3-Tesla MRI at Diagnostic Outpatient Imaging. This is El Paso’s only radiology imaging center that offers this technology. Patients do not always realize how important image quality is: It can make the difference in the diagnosis.

3-Tesla MRI is like HD TV and once you try it, you will not want to go back. The increased magnet strength gives us many benefits at no additional expense to the patient. It gives us the ability to scan faster or to scan with higher detail. An MRI of the brain can take 20 minutes and have exceptional quality, or we can perform the scan in less time, with better quality that is achieved on most 1.5 Tesla “high field” MRIs. This is incredibly useful for children.

Our 3T MRI can perform Diffusion Tensor Imaging, MRI Spectroscopy and CSF flow studies to name just a few of its possibilities.

This scanner is not only very fast, it is very large. Our open MRI has a clearance of 35 cm. The 3T has a diameter of 71 cm! This is welcome news for nervous or claustrophobic patients, and combined with its speed, it can actually eliminate the need for sedation for some patients. 3T MRI is faster, clearer, and has more diagnostic possibilities. We are certain you and your patients will notice the difference.

Our Services

MRI’s:

DOI has three MRI’s under one roof. All are American College of Radiology (ACR) Certified.

Good

Open MRI (0.35 Tesla): This MRI perfect for claustrophobic and very large patients. There is no table weight limit on this MRI

Better

High Field 1.5 Tesla MRI- This is a eight channel MRI with high end image quality. It is in a beautiful room and has ‘pianissimo’ technology, which makes the MRI relatively quiet. This machine has been the best MRI in private practice in El Paso for years. It will soon be eclipsed by our new 3.0 Tesla MRI.

Best

High Field 3.0 Tesla MRI- This is the only 3.0 Tesla MRI in private practice in El Paso. This technology can deliver stunning image quality, which can actually make a difference in your diagnosis. The increased magnet strength gives us many benefits at no additional expense to the patient.�??It gives us the ability to scan faster, or to scan with higher detail. This is welcome news for nervous or claustrophobic patients, and as well as for children as it can actually eliminate the need for sedation in some patients. 3T is faster, clearer, more diagnostic for a better for MRI. It is like HD TV. Once you have tried it, you won’t want to go back. This MRI effectively doubles our MRI capacity. If needed most exams can be completed in under 5 minutes, instead of the normal 30-45 minutes.

Breast MRI:

DOI began Breast MRI in July 2007, being the first facility in El Paso to perform the exam. We have now performed over 2500 breast MRI’s and many MRI-guided breast biopsies. All have been interpreted and/or performed by Dr. Boushka, making him the most experienced radiologist in the city with this exam. This is the most powerful tool for the detection of Breast cancer to date.

Hours:
Monday to Thursday 7 am to 9 pm
Friday 7 am to 5 pm
Saturday 8 am to 4 pm

Prostate MRI:

Guys, you need great medical care also. We are the only facility in El Paso performing this leading edge exam. MRI can see cancers when other imaging methods cannot. Not only can we see prostate cancers with MRI, we can perform MRI-guided prostate biopies for pathologic (definitive) diagnosis.

 

Monday to Thursday 7 am to 9 pm
Friday 7 am to 5 pm
Saturday 8 am to 4 pm

CT:

We have a 16 slice Toshiba Aquillion CT scanner, with newly updated in Dec 2013. The upgrade allows for reduced X-ray dose, higher resolution, more patient comfort, shorter breath holds and doubles the speed of the scanner. This scanner performs CT X-ray exams as helical volume acquisitions in 3D from a single patient exam. Most exams are finished in under 60 seconds, unless delayed images with contrast are indicated. Additionally we have a powerful 3D post processing workstation.

Hours
Monday to Friday 7 am to 6 pm

Ultrasound:

DOI has just doubled our Ultrasound capacity with newly purchased Philips 34 XRL scanner. We have Three certified Ultrasonographers with cumulative experience of 45 years. We are confident you will find them professional and compassionate. Beverly Bruner RDMS, Sonographer, formally of Desert Imaging has joined our team.

3D OB Ultrasounds:

You better believe it. Available whenever our US department is open. No referral necessary. Images are reviewed by an actual radiologist.

Ultrasound Hours:
Monday, Tuesday, Thursday 8 am to 5 pm
Wednesday 8 am to 8 pm
Friday 8 am to 5 pm
Saturday 8 am to 12 pm

Digital Mammography

DOI was the first facility in El Paso to acquire Hologic Full Field Digital Mammography and thus we have more experience with this technology than any facility in El Paso. Our Mammographer has 20 years of experience and has her own following of patents who seek her out to perform their mammograms because of her excellent and compassionate care. Our private pay screening mammography price of $90, including the interpretation is an unbeaten price in El Paso.

Hours
Mon – Fri 8am to 4pm
Extended hours Wednesday until 8pm)
Saturdays 8am to 12pm

Bone Denisity (DEXA)

We have a brand new, Hologic Discovery CI bone densitometer scanner. This is the latest technology.

X-Ray

Our digital computed radiography was just updated February 2014. No appointments are necessary.

We look forward to serving you.

 

 

Sincerely,
William M Boushka, MD

Contact Us

Get in touch with us!

Please note that we can answer general questions, but anything specific to your medical case should be discussed with your physician.

Referral Form

New Patient Forms:
New Patient Form – English
New Patient Form – Spanish

Patient History Form:
Patient History – English
Patient History – Spanish

Patient Release Form:
Patient Release Form

Diagnostic Outpatient Imaging
6065 Montana, Suite A6
El Paso, TX 79925
Tel: (915) 881-1900
Fax: (915) 771-9345

Scheduling:
Tel: (915) 881-1900

Billing & Payments:
Medical Billing Unlimited
5959 Gateway West Suite 120
El Paso, TX 79925
(915) 779-1716

Email:�mail@dximaging.com

The Importance of MRI for Herniated Disc Diagnosis | Scientific Specialist

The Importance of MRI for Herniated Disc Diagnosis | Scientific Specialist

There are a number of important factors to take into consideration, such as the timing of when an MRI scan must be performed and limitations with interpretation of findings, to get an MRI scan for herniated discs.

 

To begin with, the difficulty with the results of an MRI scan, as with a number of other diagnostic studies, is that the abnormality may not always be the source of an individual’s back pain or other symptoms. Numerous studies have shown that approximately 30 percent of people in their twenties and forties have a lumbar disc herniation in their MRI scan, even though they don’t have any pain.

 

An MRI scan cannot be interpreted on its own. Everything Has to Be well-correlated into the individual patient’s condition, for example:

 

  • Symptoms (such as the duration, location, and severity of pain)
  • Any deficits in their examination

 

Another concern with MRI scans is the time of when the scan is done. When a patient has experienced the following symptoms would be the only time that an MRI scan is needed immediately:

 

  • Bowel or bladder incontinence
  • Progressive weakness due to nerve damage in the legs.

 

Herniated Disc Analysis with MRI

 

Obtaining an MRI (magnetic resonance imaging) can be an important step in correctly assessing a herniated disc in the spine. Unlike an X-ray, MRI uses a magnetic field and a computer to create and record detailed pictures of the internal workings of your entire body. This technology can also be capable of producing cross-sectional views in identifying a disc of the body, which greatly help doctors. MRI scans are based on new technology, but they have become essential in diagnosing a number of back and neck issues, such as spinal stenosis, herniated discs and bone spurs.

 

An MRI scan has a number of benefits that greatly help a herniated disc patient. The advantages of an MRI can be:

 

  • Unobtrusive
  • Painless and free of radiation
  • Can focus on a particular part of the entire body
  • Extremely accurate

 

Diagnosing Disc Herniation

 

Should you believe you have a herniated disc in the neck or back, the very first step would be to visit a physician. Your physician will have the ability to supply you with a complete evaluation and inspection of your medical history to create a identification. Following that, you may be referred to execute an MRI stabilize and to confirm the herniated disc.

 

 

 

 

At the imaging center you’ll be put to the tubular MRI machine to get a body scan. You may remain enclosed in the MRI device for up to an hour while the comprehensive scan of place where the herniated disc along the spine is completed. The MRI can reveal the exact condition of the herniated disc and surrounding arrangements. This allows your doctor to produce the treatment plan that is right for you and to understand the origin of the disc damage and pain.

 

Herniated Disc Follow-Up Treatment

 

Most patients are able to successfully treat herniated disc pain using nonsurgical standard treatments prescribed by their physician. These include relaxation, compression treatment and mild exercise. Surgery can then be explored when months or weeks of treatment do not bring a return to previous action.

 

If you’re researching surgical options and have become concerned by a number of the risks and unsuccessful results of traditional open back operation, contact a specialist. Spine surgery specialists perform minimally invasive spine surgery, including invasive stabilization surgeries and minimally invasive decompression, which can treat a number of the very acute herniated discs. They may review your MRI to determine if you are a candidate for minimally invasive spine surgery, which may help you get your life back.

 

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�Green-Call-Now-Button-24H-150x150-2.png

 

By Dr. Alex Jimenez

 

Additional Topics: Sciatica

 

Lower back pain is one of the most commonly reported symptoms among the general population. Sciatica, is well-known group of symptoms, including lower back pain, numbness and tingling sensations, which often describe the source of an individual’s lumbar spine issues. Sciatica can be due to a variety of injuries and/or conditions, such as spinal misalignment, or subluxation, disc herniation and even spinal degeneration.

blog picture of cartoon paperboy big news

 

TRENDING TOPIC: EXTRA EXTRA: New PUSH 24/7�? Fitness Center

 

 

MRI To Evaluate Lumbar Posterior Ligament Complex Post Trauma

MRI To Evaluate Lumbar Posterior Ligament Complex Post Trauma

The importance of Magnetic Resonance Imaging to evaluate the integrity of the lumbar posterior ligament complex post trauma.

Abstract: Posterior ligamentous complex(PLC), consisting of the supraspinous ligament, interspinous ligament, ligamentum flavum, and the facet joint capsules is thought to contribute significantly to the stability of the lumbar spine. There has been much debate on whether Magnetic Resonance Imaging(MRI) is specific and sensitive in diagnosing pathology to the PLC. The objective is to determine the necessity of MRI imaging for evaluating the integrity of the lumbar posterior ligament complex post trauma.

Key Words: Magnetic Resonance Imaging(MRI), interspinous ligament, posterior ligament complex, low back pain, ligament laxity, electromyography, impairment rating

A 41-year-old male, presented to my office for an examination with complaints of low back pain with numbness, tingling and weakness into the left lower extremity after he was the restraint driver in a motor vehicle collision approximately three and a half months� post trauma.�He�rated the pain as a�3/10 on a visual analog scale with 10/10 being the worst and the pain and noted the pain as being�present most of the time.� He stated that he was on pain killers daily and this helped manage his daily activities. Without pain killers his pain levels are rated 8/10 being present most of the time. The pain killers stated by the patient are Oxycodone and Naproxen.
He�reported that the pain would be aggravated by activities which required excessive standing, repetitive bending, and lifting. He further noted that in the morning the pain was increased and his left leg would be numb and weak for about the first hour.

The patient stated that his care to date had been managed by a pain management clinic and that he had minimal improvement with treatment which has included physical therapy and massage therapy. He reported the pain clinic next recommended steroid injections which he refused. He states there has been was no imaging ordered and that an Electromyography(EMG) had been performed. He was told the test was negative for pathology.

Prior History: No significant medical history was reported.
Clinical Findings:�The patient is 6�0� and weighs 210 lbs.

Physical Exam Findings:

Cervical Spine:
Cervical spine range of motion is full and unrestricted. Maximum cervical compression is negative. Motor and other regional sensory exam are unremarkable at this time.

Thoracic Spine:
Palpation of the thoracic spine region reveals taught and tender fibers in the area of the bilateral upper and mid thoracic musculature. Thoracic spine range of motion is restricted in flexion, extension, bilateral lateral flexion, and bilateral rotation. Regional motor and sensory exam are unremarkable at this time.

Lumbar Spine:
Palpation of the lumbosacral spine region reveals taught and tender fibers in the area of the lumbar paraspinal musculature. Lumbar spine range of motion is limited in flexion, extension, bilateral lateral flexion and bilateral rotation. Extension restriction is due to pain and spasm. Straight leg raise causes pain at approximately 50 degrees when testing either side in the left low back. There is no radicular symptomatology down the leg. Kemp�s maneuver recreates pain in the L4 region on the left. No radicular symptoms are noted. The patient is able to heel and toe walk. Regional motor and sensory exam is unremarkable at this time other than L4, L5 and S1 dermatomes having decreased sensation with light touch.

Muscle testing of the upper and lower extremities was tested at a 5/5 with the exception of the left quadricep tested at a 4/5.� The patient�s deep tendon reflexes of the upper and lower extremities were tested including triceps, biceps, brachioradialis, patella, and Achilles and all were tested at 2+ bilaterally except the left patellar reflex was 1+.

RANGES OF MOTION EVALUATION

All range of motions are based on the�American Medical Association�s Guides to the Evaluation of Permanent Impairment, 5th�Edition1�and performed by a dual inclinometer for the lumbar spine.

�� Range of Motion������Normal�������� Examination�������� % Deficit

Flexion 60 48 20
Extension 25 12 52
Left Lateral Flexion 25 16 36
Right Lateral Flexion 25 18 28

An MRI was ordered to rule out gross pathology.

Imaging:

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A lumbar MRI reveals;
1)��� Mild disc bulges at T11-T12, T12-L1, L1-L2 and L5-S1
2)��� Low disc signals indicative of disc desiccation at T11-T12, T12-L1, L1-L2, L2-L3, L3-L4 and L4-L5
3)��� Retrolisthesis of 2mm at L3-L4
4)��� Mild ligamentous hypertrophy at L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1
5)��� L4-L5 has a Grade 1-2 tear of the interspinous ligament with mild inflammation
6)��� L5-S1 has a Grade 1 interspinous ligament tear with mild inflammation

After reviewing the MRI I ordered lumbar x-rays to rule out ligament laxity.

X-RAY STUDIES

Lumbar x-rays reveal the following:
1)��� Left lateral tilt
2)��� Retrolisthesis at L1 of 3mm
3)��� Retrolisthesis at L2 of 3mm
4)��� Combined excessive translation of 4mm of L1 during flexion-extension
5)��� Combined excessive translation of 4mm of L2 during flexion-extension
6)��� Excessive translation of L3 in extension posteriorly of 2.5mm
7)��� Decreased disc space at L5-S1

Chiropractic care was initiated. The patient was placed on an initial care plan of 2-3x/week for 3 months and then a recommended break in care for one month so the patient could be evaluated for permanency while he was not care dependent.

At maximum medical improvement, he had continued low back pain rated 4/10, continued numbness and tingling into his left leg and left quadricep weakness rated 4/5. He does not need pain killers for pain management anymore. He continues chiropractic care every two weeks to manage his symptoms.

Conclusion:
In this specific case, pathology to the posterior ligament complex diagnosed on MRI lead to the x-ray finding of excessive translation at L1-L2 and L2-L3. The patient was given a permanent impairment rating of 22% based on my interpretation of the American Medical Association�s Guides to the Evaluation of Permanent Impairment, 5th�Edition1. The interspinous ligament tears at the L4-L5 and L5-S1 level would not have been diagnosed without the MRI.

There has been much debate on whether MRI imaging has a role in evaluating lumbar PLC. MRI is a powerful diagnostic tool that can provide important clinical information regarding the condition of the PLC. Useful sequences for spinal MRI in trauma include sagittal and axial T1-weighted images, T2-weighted FSE, fat-saturated T2-weighted FSE, and STIR sequences to highlight bone edema.2�Ligamentous injuries are best identified on T2-weighted images with fat saturation because the ligaments are thin and bonded on either side by fat, which can appear as hyperintense on both T1 and T2 images.3�T1-weighted images are inadequate in isolation for identifying ligamentous injuries.4�

The diagnostic accuracy for MRI was reported for both supraspinous ligament and interspinous ligament injury with a sensitivity of 89.4% and 98.5%, respectively, and a specificity of 92.3% and 87.2% in 35 patients.5
For patients with persistent symptoms after trauma an MRI may be indicated to evaluate posterior ligamentous complex integrity.

Competing Interests:� There are no competing interests in the writing of this case report.

De-Identification: All of the patient�s data has been removed from this case.

References:
1. Cocchiarella L., Anderson G. Guides to the Evaluation of Permanent Impairment, 5th Edition, Chicago IL, 2001 AMA Press.
2. Cohen, W.A., Giauque, A.P., Hallam, D.K., Linnau, K.F. and Mann, F.A., 2003. Evidence-based approach to use of MR imaging in acute spinal trauma.�European journal of radiology,�48(1), pp.49-60.
3. Terk, M.R., Hume-Neal, M., Fraipont, M., Ahmadi, J. and Colletti, P.M., 1997. Injury of the posterior ligament complex in patients with acute spinal trauma: evaluation by MR imaging.�AJR. American journal of roentgenology,�168(6), pp.1481-1486.
4. Saifuddin, A., Green, R. and White, J., 2003. Magnetic resonance imaging of the cervical ligaments in the absence of trauma.�Spine,�28(15), pp.1686-1691.
5. Haba H, Taneichi H, Kotani Y, et al. Diagnostic accuracy of magnetic resonance imaging for detecting posterior ligamentous complex injury associated with thoracic and lumbar fractures.�J Neurosurg. 2003; 99(1 Suppl):20-26.

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