Comprehensive Spine Tests and Diagnosis

PACE Hospitals combines advanced imaging and expert evaluation to diagnose spine conditions early and accurately, enabling effective and patient-centred care.

Basic Imaging Studies (First-line tests)

X-ray

An X-ray is usually the first test done when there is back or neck pain. It uses a small amount of radiation to create images of the bones in the spine. This test helps doctors check for problems like fractures, misalignment of the spine, slipped discs (indirectly), arthritis, or abnormal curvatures such as scoliosis. Although it does not show soft tissues like nerves or discs clearly, it gives a quick and useful overview of the spine structure and helps guide further tests if needed.

Magnetic Resonance Imaging (MRI)

MRI is gold standard tests for diagnosing spine problems. This is utilised to create detailed images of the spine, including discs, nerves, spinal cord, and surrounding soft tissues. This test helps doctors identify conditions like herniated discs, nerve compression, spinal cord injuries, infections, tumors, and degenerative spine diseases. MRI is especially helpful when symptoms like pain, numbness, or weakness suggest nerve involvement, as it shows exactly where the problem is.

Computed Tomography (CT) Scan

A CT scan uses X-rays along with computer technology to create detailed cross-sectional images of the spine. It provides clearer and more detailed images of bones compared to a regular X-ray. This test is useful in detecting complex fractures, bone abnormalities, spinal stenosis, and certain malignancies. It is used when a more detailed image of the bone structure is required, or MRI scans can not be performed on some patients.

Advanced Imaging Techniques

CT Myelogram

CT myelogram is a comprehensive imaging technique that combines computed tomography (CT) with a contrast dye injected into the spinal canal to improve visualization of the, nerve roots, spinal cord, and surrounding structures. This technique is beneficial especially for identifying spinal disorders when other imaging procedures, such as traditional X-rays or MRI, are unclear or not appropriate.

Magnetic Resonance Myelography (MRM)

Magnetic Resonance Myelography (MRM) is an advanced imaging technology that uses magnetic resonance imaging (MRI) and a contrast dye (often gadolinium-based) to see the spinal cord, nerve roots, and subarachnoid space. The contrast dye is introduced into the subarachnoid area either by a lumbar puncture or intravenously, and the MRI scanner generates highly detailed images of the spinal canal and nerve structures.

Positron Emission Tomography (PET) Scan

The Positron Emission Tomography (PET) Scan is a specialized imaging technology that produces precise, functional images of the spinal cord and surrounding tissues. PET scans identify metabolic activity by measuring the radiation released by a small amount of radioactive tracer (often glucose or other compounds). The tracer is injected into the body and absorbed by tissues, releasing positrons that are detected by the PET scanner. The generated images show areas with significant metabolic activity, which may indicate inflammation, tumors, infection, or nerve degeneration in the spinal cord.

Bone Scan (Scintigraphy)

A bone scan, which is also called scintigraphy is an imaging test that helps detect issues in the bones of the spine. It uses a small amount of safe radioactive material that is injected into a vein, which collects in areas where the bone is actively changing or damaged. This helps doctors identify conditions like infections, fractures that may not show up on X-ray, tumors, or inflammation. It is especially helpful when the root cause of back pain is unconclusive or when several areas of the spine need to be examined.

Spinal Ultrasound

Spinal ultrasound uses sound waves to create images of the spine and surrounding soft tissues. It is commonly used in infants and young children, where the bones are not fully developed, allowing clearer visualisation. In adults, it is mainly used to guide procedures like injections rather than to diagnose deep spine problems. It can help detect fluid collections, soft tissue swelling, or certain abnormalities near the spine in a safe and radiation-free way.

Neurophysiological Studies

Electromyography (EMG)

Electromyography (EMG) is a diagnostic procedure that assesses muscle electrical activity and motor neuron function. It involves inserting a needle electrode into muscle tissue to detect unusual electrical signals that may suggest nerve injury or dysfunction. EMG is used to evaluate the consequences of spinal cord damage, nerve root compression (as in radiculopathy), and conditions such as multiple sclerosis and amyotrophic lateral sclerosis (ALS). It aids in detecting nerve root involvement, determining the extent of motor neuron injury, and tracking the progression or recovery of muscle and nerve function. EMG gives crucial information about how spinal cord disorders affect muscle strength, nerve conduction, and motor control.

Nerve Conduction Studies (NCS)

Nerve Conduction Studies (NCS) is a diagnostic examination that assesses the speed and strength of electrical signals passing through nerves. Electrodes are positioned on the skin over certain nerves, and a moderate electrical shock is used to induce nerve activity. NCS assesses how well electrical impulses flow along peripheral nerves (nerves outside the spinal cord), which aids in detecting nerve damage or dysfunction caused by spinal cord disorders such as radiculopathy, spinal cord injury, multiple sclerosis, or diabetic neuropathy. NCS can establish whether nerve damage is caused by compression, degeneration, or inflammation by analyzing the conduction velocity and amplitude of nerve impulses, and this information can help to guide treatment options in spinal cord conditions.

Invasive Diagnostic Procedures

Spinal Fluid Analysis (Lumbar Puncture or Spinal Tap)

Spinal fluid analysis (also known as lumbar puncture or spinal tap) is a diagnostic procedure in which a needle is placed into the lumbar region (lower back) to collect a sample of cerebrospinal fluid, which surrounds the brain and spinal cord. This fluid is examined for abnormalities that could indicate the presence of infections, inflammation, disease processes, or neurological problems affecting the spinal cord. This test is very beneficial for detecting multiple sclerosis, spinal cord infections (such as meningitis or encephalitis), Guillain-Barré syndrome, and autoimmune conditions. CSF examination may reveal high amounts of white blood cells, protein, or the presence of unusual antibodies, providing vital information about the underlying cause of neurological symptoms and help guide treatment methods.

Discography

Discography is a specialised test used to find out if a particular spinal disc is causing pain. During the procedure, a small amount of contrast dye is injected into one or more discs under imaging guidance. If the injection reproduces the patient’s usual pain, it helps confirm that the disc is the source of the problem. This test is often used when planning spine surgery, especially in cases of chronic back pain where the exact cause is not clear from MRI or CT scans.

Facet Joint Injection (Diagnostic)

Facet joint injection is both a diagnostic and therapeutic procedure. A small amount of local anaesthetic, sometimes with a steroid, is injected into the facet joints of the spine (the joints that help the spine move). If the pain reduces after the injection, it confirms that the facet joints are the source of pain. This helps doctors diagnose conditions like facet joint arthritis and decide on further treatment options, including minimally invasive procedures.

Vascular Studies

Cerebral Angiography

Cerebral angiography is a specialized imaging technique that employs X-rays and a contrast dye to see blood arteries in the spinal cord and brain. The contrast dye is injected into the arteries, usually by a catheter placed into the femoral artery (groin) or directly into the spinal artery. The dye improves X-ray imaging, allowing for more comprehensive visualization of the vascular structures that provide blood to the spinal cord and surrounding tissues, such as the arteries, veins, and capillaries.

Laboratory Investigations

Blood Tests

• Inflammatory markers: Inflammatory markers helps detect inflammation in the body. Common tests include Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP). When these levels are high, it may indicate conditions such as spinal infections, inflammatory arthritis, or diseases affecting the spine like ankylosing spondylitis. These tests do not show the exact location of the problem but help doctors understand if inflammation is contributing to spine pain or stiffness.
• Complete blood count (CBC): A CBC is a basic blood test that measures red blood cells, white blood cells, and platelets. It helps doctors identify signs of infection, anemia, or other underlying health conditions. In spine-related problems, an increased white blood cell count may suggest a spinal infection, while other changes can give clues about overall health before planning surgery or treatment.
• Autoimmune markers : Autoimmune markers are used to detect conditions in which the body's immune system mistakenly attacks the body's own tissues. Tests such as Antinuclear Antibody (ANA), HLA-B27, and rheumatoid factor (RF) help identify diseases like ankylosing spondylitis, rheumatoid arthritis, or other inflammatory spine disorders. These conditions can cause long-term back pain, stiffness, and reduced mobility, and early detection helps doctors plan appropriate medical or surgical treatment.
• Cerebral Spinal Fluid (CSF) Cytology and Culture: Cerebrospinal Fluid (CSF) Cytology and Cultures are laboratory procedures done on a sample of cerebrospinal fluid (CSF) collected through lumbar puncture or spinal tap. These tests analyze the composition of cells and microbial content of cerebrospinal fluid in order to detect many conditions affecting the spinal cord and brain, especially those related to infections, inflammation, or malignancies.

Specialized / Emerging Techniques

Functional MRI (fMRI)

Functional MRI is a special type of MRI that shows how different parts of the brain are working by tracking blood flow changes. In spine-related cases, it is sometimes used when the spinal problem affects the brain or nerve pathways. It helps doctors understand how nerves are functioning and can be useful in planning complex spine or nerve-related surgeries, especially when protecting important functions like movement or sensation is critical.

Diffusion Tensor Imaging (DTI)

Diffusion Tensor Imaging (DTI) is an advanced MRI technique that shows the pathways of nerves in the spinal cord and brain. It helps doctors see how nerve fibers are arranged and whether they are damaged or compressed. This is especially helpful in conditions like spinal cord injury, tumors, or severe nerve compression, where understanding the exact location and extent of nerve damage is important before surgery.

Intraoperative neuromonitoring (during surgery)

Intraoperative neuromonitoring is used during spine surgery to continuously check the function of nerves and the spinal cord. These are specialised sensors that are placed on the body to monitor nerve signals while the surgery is being performed. If there are any changes in nerve function, the surgical team is alerted immediately, allowing them to adjust the procedure and prevent potential nerve damage. This helps improve the safety of complex spine surgeries.

Genetic testing

Genetic testing involves analysing an individual's DNA material , usually through a blood sample, to identify inherited conditions. In spine care, it may be used to detect genetic disorders that affect the spine, such as certain deformities, connective tissue disorders, or inflammatory conditions. It helps doctors understand the underlying cause of the disease, assess the risk of progression, and plan long-term management, especially in patients with a family history of spine problems.

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Get a free second opinion from expert spine specialists.

At PACE Hospitals, we are committed to providing our patients with the best possible care, and that includes offering second medical opinions with super specialists for treatment or surgery. We recommend everyone to get an expert advance medical second opinion, before taking decision for your treatment or surgery.