Spinal Stenosis Diagnosis: Exams and Tests

After a physical and neurological examination, your doctor may recommend an x-ray, CT scan, MRI or other test to diagnose the cause of cervical and lumbar spinal stenosis symptoms.

In most patients the evaluation of spinal stenosis begins with a comprehensive physical and neurological examination often followed by confirmatory imaging tests (eg, x-ray). In some cases, electrodiagnostic studies are necessary to evaluate the function of certain muscles and nerves. The types of tests your spine specialist recommends depend on findings from your medical history and exam outcomes. Imaging tests provide valuable information about the cause of your spinal stenosis and confirm the doctor’s diagnosis.
Doctor reviewing patient x-rayImaging tests provide valuable information about the cause of your spinal stenosis and confirm the doctor’s diagnosis.Medical History, Symptoms, Physical and Neurological Examinations
Your spine specialist carefully reviews your medical history, which may include a family history. Some spinal disorders may be inherited, or risk increased if a parent has a history of neck or back pain. In general, existing medical problems (eg, diabetes, cardiovascular disease), current medications taken (over-the-counter, prescription), previous spine treatments and surgeries, and lifestyle (eg, tobacco and alcohol use, exercise) are vital.

Questions your spine specialist may ask about your symptoms include:

  • Describe your symptoms (eg, pain, numbness, tingling sensations)
  • When did your symptoms begin?
  • Where is your pain? Does it radiate into another part of your body?
  • What is the frequency of your symptoms?
  • On a scale from 1 to 10 with 10 being the worse pain imaginable, how do you rate your pain now?
  • What improves your symptoms? What makes your symptoms worse?
  • Does leaning forward or sitting relieve your pain?
  • What treatments have you tried and with what level of success?

During the physical examination, the doctor inspects your spine for abnormalities (such as kyphosis, scoliosis, abnormal curvature of the spine) and areas of swelling, tenderness, and pain. He/she observes your posture, and how you walk and stand. Your flexibility and spinal range of motion is assessed as you bend forward and backward and from side-to-side.

The purpose of a neurological exam is to learn more about your pain and nerve-related symptoms (eg, numbness, tingling, burning sensations). Your spine specialist may test your muscle strength, reflexes, balance, and your gait.

Questions your spine specialist may ask during your neurological exam may include — do you experience:

  • Difficulty walking, climbing stairs, walking downhill?
  • Weakness in your arms and/or leg? If so, is it constant or does it come and go?
  • Cramps in your legs?
  • Muscle twitching?
  • Problems with your bowel or bladder function?

Electrodiagnostic tests: Your spine specialist may order an Electromyogram (EMG) and/or Nerve Conduction Study (NCS) to measure the electrical performance of your muscles and nerves.

Imaging Tests for Spinal Stenosis
If your symptoms and initial exams are suggestive of spinal stenosis, your spine specialist may recommend an imaging test to confirm the diagnosis and the underlying cause. Depending on the severity of symptoms, an imaging test is performed if symptoms do not subside after 3 to 6 months of non-surgical treatment—such as rest, anti-inflammatory medications, and physical therapy.

Typically, plain x-rays (radiographs) are a first-line imaging test performed for spinal stenosis. X-rays are helpful in some cases to identify infection, tumors, and spinal alignment problems (eg, abnormal kyphosis, scoliosis). Radiographs may reveal thinned disc space, fracture, bone spurs (osteophytes), or osteoarthritis (spondylosis)—all of which can reduce the size of the spinal canal and/or spinal nerve passageways and lead to compression.

While x-rays are often the first test your spine specialist orders, it may not be the only one. Sometimes a more detailed imaging study is needed to evaluate your spine’s anatomical structures—such as the bones, discs, ligaments and nerves. A CT or CAT scan (computerized axial tomography) or MRI (magnetic resonance imaging) are good imaging tests that provide detailed information your doctor needs to help diagnose spinal stenosis and its cause.

A bone scan, or bone scintigraphy, is a nuclear imaging test performed to detect disorders affecting bone and it’s metabolism—such as metastatic cancer, arthritis, Paget’s disease, fracture, and osteomyelitis (infection). A radioactive drug or dye, called a tracer is injected into a vein in your arm. After the tracer is administered, time is given to allow it to be absorbed by your bones (two or more hours). Then, a tracer-sensitive camera scans your body while you lie on the testing table.

A myelogram or myelography is performed to evaluate your spinal cord, spinal meninges, and nerve roots for compression. A contrast dye is injected into your spinal canal followed by an x-ray or CT scan.

If your physician thinks you may need implants placed in the spine to correct instability or to help fix an abnormal curvature of the spine (scoliosis), then a dual-energy x-ray absorptiometry (DEXA) scan may be necessary. The DEXA scan can help to assess the density or hardness of your bone and indicate if you have weak bones (osteoporosis).

Exams and Tests Help Confirm Spinal Stenosis and Its Cause
When your spine specialist has a comprehensive bank of information—your medical history, outcomes from your physical and neurological exams, and imaging test results—he or she is best positioned to make an accurate diagnosis of cervical or lumbar spinal stenosis. If you’re experiencing back or neck pain and symptoms that may be spinal stenosis, talk to your doctor. The sooner you know what’s causing your pain, the quicker you can find the right treatment to reduce it.

Updated on: 04/11/18
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6 Topics to Help You Talk with Your Spine Surgeon

SpineUniverse spoke with Lali Sekhon, MD, PhD, FACS to obtain his advice about preparing for and getting the most from an appointment or consultation with a spine surgeon.
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