Disc herniation

Spinal Disc Herniation: When Are Scans Indicated?

There are several imaging techniques medical doctors and specialists use to diagnose spinal disc herniation. Some imaging techniques are preferred over others when practitioners aim to rule out specific spinal disc or related injuries. Plain radiograph (X-rays) or more advanced imaging techniques like Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) may be ordered in back pain associated with spinal nerve root irritation (radiculopathy) or spinal cord compression (spinal stenosis) and back pain associated with progressive neurologic deficits, such as muscle weakness and wasting.

Red flags
Red flags are indicators of possible serious pathology such as inflammatory or neurological conditions, structural musculoskeletal damage or disorders, circulatory problems, suspected infections, tumours or systemic disease. If suspected, these require urgent medical investigation and sometimes a surgical referral. In these circumstances, scans usually form an important role in the overall investigative and diagnostic procedure. There are certain signs and symptoms that when observed in a patient’s examination or history alert practitioners to the fact that something could be seriously wrong. In the case of musculoskeletal disorders, physiotherapists and chiropractors are highly trained to identify and rule out red flags.

Red flag signs and symptoms include, but are not limited to:

  • Bowel and bladder changes
  • Unexplained and sudden weight loss or gain
  • Unrelenting night pain that makes sleep difficult
  • Night sweats, fever, chills and malaise (uneasiness)
  • Progressive neurological deficit, such as loss of strength, sensation, muscle wasting and reflexes in the lower limbs

Serious pathology may also indicate scans. These include, but are not limited to:

  • Fracture or dislocation
  • Tumour or previous history of cancer
  • Serious traumatic accident, such as a motor vehicle accident
  • Cauda equina syndrome (characterised by a loss of sensation in the buttocks, perineum and inner surfaces of the thighs, bowel and bladder changes or sexual dysfunction)

However, it is important to keep in mind that red flags and serious pathology is cause of low back pain in less than 2% of patients.

Non-specific low back pain
Conservative (or physical) therapy with assessment in 4-6 weeks is recommended as the primary intervention for patients with non-specific or mechanical back pain (without the presence of serious pathology and red flags). Chiropractors and physiotherapists are highly qualified in providing physical therapy to patients with mechanical spine pain. The natural history of low back pain is favourable with improvement over time, and so patient reassurance is also very important. This is clinically relevant in patients with disc herniation.

So, if you have low back pain and you bent over and ‘felt it go’, you woke up and it was sore, you lifted something, or did a movement at work or playing sport – a scan is most likely not going to change anything. Physiotherapists and chiropractors are trained to take quality case histories and use a variety of clinical techniques and investigations, such as orthopaedic and neurological testing and physical or functional testing, to rule out red flags and diagnose and treat musculoskeletal disorders and symptoms of disc herniation.

To learn more about disc herniation, please follow the link to read an overview on herniated lumbar discs.

Martin Frutiger chiro

Martin Frutiger

Martin is an experienced and qualified chiropractor, remedial massage therapist and has completed a Masters of Research. He has an active interest in sports conditions, over use injuries and problems related to the spine such as neck and back pain.