Consulting a Spine Specialist

There are a number of disorders that can be responsible for inflicting back pain. Besides sore muscles and sprains, there are congenital and degenerative diseases, infections and, on rare occasions, tumors that can affect the bony and soft spinal tissues.

The spine is a compact environment occupied by bony structures, groups of muscles, ligaments, tendons, and nerves all living side by side. This arrangement is similar to a neighborhood (spinal column) where the homes (vertebrae) have been built close together. If one house catches on fire (e.g. pain from a nerve that is compressed), the one next-door will likely be affected in some way. Similarly, it is important to locate the source of the fire and extinguish it before the whole block is on fire.

Some patients do not understand why they are in such agony. Their pain, when linked with apprehension, may promote feelings of anxiety and fear. Perhaps the patient does not know who to turn to or who to see about their disorder. Depending upon the parameters of the patient's health insurance plan, their primary care physician may provide a referral if it is determined that more than routine care is necessary.

At this point, let's assume the patient has made an appointment to see a specialist. What is next? It might be a good idea to gather information the physician needs prior to the office visit. The following checklist should be helpful.

1. X-rays, MRIs, or other tests performed relevant to the current problem.

2. Make a few notes describing the type of pain, its location, when the problem started.

3. Medical history including allergies, illnesses, family medical history, prior surgeries.

4. The names and dosages of current medications.

5. Jot down questions to ask the physician.

The next step is the physician's examination of the patient. The examination is made up of three basic steps: 1) Review the patient's medical history, 2) the physical examination, and 3) diagnostic tests, if needed. After the patient completes their paperwork, the assistant asks the patient questions necessary to complete their preliminary chart. Shortly thereafter, the physician arrives with the patient's chart in hand and greets them.

The physician will ask the patient to clarify any unclear aspects of the medical history. In addition, the doctor may ask auxiliary questions to gain a good understanding of the patient's past and current medical condition. Then the conversation will shift to a direct discussion about the patient's current disorder. After asking questions about the patient's condition, sometimes the physician is able to arrive at a preliminary diagnosis by carefully listening to the patient and analyzing what they have said in terms of symptoms, past medical treatment, and family history. An accurate diagnosis is the key to the success of the treatment plan.

The second step is the physical examination. At this point, the patient may be asked to change into an examination gown. Depending on the patient's physical condition, the doctor may ask the patient to walk, stand, sit, and move their arms and/or legs. During this time, the doctor observes the patient's ability to move and their range of motion. Certain physical tests examine bilateral response, muscle strength, reflexes, and palpation.

The last step is diagnostic testing. During the last two steps, the physician has gathered information regarding the patient's condition. At this point, the doctor most likely has determined a probable diagnosis. It is important for the patient to understand that tests are not done at random. Not every patient's problem will require an X-Ray, CT Scan, EMG, or lab tests.

Some disorders can be defined by clinical findings. The "clinical findings" are clues the physician detects during the course of his examination, both verbal and physical. Most disorders, simple or complex, have distinguishing characteristics. When testing is ordered, it is done to confirm the diagnosis.

Diagnostic tests are of great value. When the test results are combined with the findings from the first two steps, it is a win-win situation for both the physician and the patient. The physician is able to formulate an accurate diagnosis and offer the patient the best treatment options.