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Diagnosing Spinal Stenosis

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.

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.

Computerized axial tomography (CAT)‚ x-rays are passed through the back at different angles, detected by a scanner, and analyzed by a computer. This produces a series of cross-sectional images and/or three-dimensional views of the parts of the back. The scan shows the shape and size of the spinal canal, its contents, and structures surrounding it.

Myelogram, a liquid dye that x-rays cannot penetrate is injected into the spinal column. The dye circulates around the spinal cord and spinal nerves, which appear as white objects against bone on an x-ray film. A myelogram can show pressure on the spinal cord or nerves from herniated disks, bone spurs, or tumors.

Bone scan‚ an injected radioactive material attaches itself to bone, especially in areas where bone is actively breaking down or being formed. The test can detect fractures, tumors, infections, and arthritis, but may not tell one disorder from another. Therefore, a bone scan is usually performed along with other tests.