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Spinal Stenosis

How is Spinal Stenosis Diagnosed?

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Updated April 08, 2014

Lumbar disc anatomy

Image of a lumbar vertabrae

Image © Medical Multimedia Group
Making the diagnosis of spinal stenosis involves a complete evaluation of the spine. The process always begins with a medical history and physical examination. Imaging studies (x-ray, MRI, etc.) are often used to determine the extent and location of the nerve compression.

  • Medical History and Physical Examination
    The medical history is the most important aspect of the examination as it will tell your doctor about your symptoms, possible causes for your spinal stenosis, and other possible causes of back pain.

    The physical examination in a patient with spinal stenosis will give your doctor information about exactly where the nerve compression exists. Some important factors that should be investigated are any areas of sensory abnormalities or numbness, the nature of your reflexes, and any muscular weakness.

  • X-Ray
    An x-ray is a simple, inexpensive procedure, and the risks of x-rays are minimal. The x-ray will show your doctor the bones of your spine. The x-ray is helpful is looking for causes of spinal stenosis including tumors, traumatic injury, spinal arthritis or inherited abnormalities.

  • Myelogram
    The myelogram is an x-ray, with an added twist. Dye is injected into the spinal fluid around the spinal cord and nerves. The dye shows up on x-rays around these nerves unless there is no space surrounding the nerves. Because of increasing use of MRIs, myelograms are much less commonly performed these days. However, they can be very useful in some situations where patients may be unable to have an MRI.

  • CT (computed tomography) Scan
    A CT scan is also similar to an x-ray, but provides a better degree of differentiation of tissues in your body; in other words, you can see more, because more structures show up on a CT scan. CT scans, often called 'CAT' scans, provide your doctor with a better view of areas of compression within the spinal canal.

  • MRI (magnetic resonance imaging)
    The MRI has become the most frequently used study to diagnose spinal stenosis. The MRI uses magnetic signals (instead of x-rays) to produce images of the spine. MRIs are helpful because they show more structures, including nerves, muscles, and ligaments, than seen on x-rays or CT scans. MRIs are helpful at showing exactly what is causing pressure on the nerves of the spine.

  • Bone Scan
    A bone scan is not a test that will detect spinal stenosis, but it can be helpful to look for problems that may be related to spinal stenosis. A bone scan is performed by injecting radioactive material into a vein, this material is attracted to areas of high bone activity. A bone scan may be used if there is concern for fractures, tumors, infections, and other potential causes of spinal stenosis.
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