Diagnostic Tests:
STOSSA has available the most advanced and sophisticated diagnostic testing equipment to accurately help in the diagnosis of the causes of back and neck pain:
Non Surgical Medical Treatment:
STOSSA employs the latest surgical procedures and techniques, but only after exhausting all of the most promising non-surgical medical treatment options and pain management techniques. Some of the pain management injections commonly used and available on-site are:
Spinetex Rehab
STOSSA has an affiliation with an on-site physical therapy practice, Spinetex Rehab. The physical and occupational therapists at Spinetex are a necessary and integral part of the treatment of spine problems. These therapists work closely with the STOSSA physicians to develop effective treatment plans for each patient. The therapists help patients who have had a variety of spinal injuries or problems. All therapists are licensed by the State of Texas. While each patient will receive a customized treatment plan, common treatments utilized are: exercise programs, stabilization techniques, soft tissue techniques, pain control therapies, and back care education.
Myelogram
What is it?
A myelogram is an older test that is still used to examine the spinal canal and spinal cord. A special dye is placed into the spinal sac that shows up on X-rays to indicate any abnormalities. Before there were CT and MRI scans, the myelogram was the best test to determine the cause of pressure on the spinal cord or spinal nerves. Today the myelogram is used only for very special purposes, such as for complicated revision spine surgeries. It is rarely the first test used if your doctor suspects you have a herniated disc.
Why is it done?
The dye used during a myelogram outlines the spinal cord and nerve roots. This helps your doctor determine if there are any unusual indentations or abnormal shapes in the spinal cord. Anything that is pushing into the nerves shows up as an indentation into the spinal sac. This indentation could be from a herniated or bulging disc, a tumor, or an injury to the spinal nerve roots. The myelogram is useful for patients who have metal plates and screws in their spine, which prevents them from having either a CT or MRI scan.
How is it done?
The doctor must perform a spinal tap to inject dye into the spinal sac. The dye mixes with the spinal fluid so that it will show up on X-rays. You will be asked to lie on a tilting table while multiple X-rays are taken to show the flow of the dye through the spine. The myelogram is usually combined with a CT scan to get a better view of the spine in cross section and to check the health of the bones and nerves.
What are the limitations?
A myelogram does not show the soft tissues. It shows only the bones and the spinal fluid where the dye has mixed with the fluid.
What are the risks?
Because the myelogram requires a spinal tap, there are more risks associated with it than most other tests. This is one reason that doctors prefer to use "noninvasive" tests first, such as the MRI and CT scan. The risks associated with a spinal tap include meningitis (infection of the spinal fluid), spinal headache, and allergic reaction to the dye. There is also a very small chance that the needle will cause bleeding around the spinal sac. The myelogram requires X-rays, which use radiation. Large doses of radiation can increase the risk of cancer. The vast majority of patients who have X-rays taken will never get enough radiation to worry about cancer. Only patients who have large numbers of X-rays-hundreds-over many years need to be concerned.
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Radionuclide Bone Scan
One of the major advantages of a radionuclide bone scan over all other imaging techniques is its ability to image the entire skeleton at once. Bone scanning provides useful information in that it can confirm the presence of diseases, demonstrate the distribution of the lesion, and help to evaluate the activity of the pathologic process. The indications for bone scanning include traumatic conditions, tumors, various arthritides, infections, and metabolic bone disease.
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Discogram (or Discography)
What is it?
A discogram is an enhanced X-ray examination of the intervertebral discs. Dye is injected into the center of the injured disc(s). The dye makes the disc clearly visible on X-ray film and on a fluoroscope (special X-ray TV screen).
Why is it done?
This test is used to determine which disc has structural damage and whether it is causing pain. A discogram can show if a disc has begun to rupture and if it has tears in the tough outer ring (the annulus). By injecting fluid into the disc to increase pressure, the doctor can tell if it is painful. This type of structural damage is a primary cause of pain within a damaged disc. Normal discs, and even those that are severely degenerated, do not usually cause pain. This test is usually done prior to surgery to help the doctor know the location of the problem and the type of operation needed.
How is it done?
You will be given medication to help you relax. A local anesthetic is applied to numb the area of the back to be tested. A long needle is inserted from the back. It goes into the nucleus pulposus (the very center of the intervertebral disc). The fluoroscope makes it possible for a doctor to see on the screen your spine and the needle as it moves. The doctor watches the screen as the needle is inserted to make sure it goes into the correct disc space. Once the needle is inside the right disc, a small amount of fluid is injected to cause an increase in pressure. More than one level is tested to determine which levels are normal. If this test causes pain that is similar to your back or leg pain, it is a good indication that the disc is causing problems. Dye is inserted into the disc, and then X-rays are taken. Commonly, a CT scan is also done to see a cross section of the disc. The procedure lasts about 40 minutes.
What are the limitations?
The discogram does not show the bones or nerves very well-only the inside of the intervertebral disc. This test is not frequently used. It is usually done after an MRI fails to show a herniated disc. Doctors also rely on the discogram when disc surgery is being seriously considered.
What are the risks?
The risks associated with a discogram include infection inside the disc and an allergic reaction to the dye. Discograms require X-rays, which use radiation. In large doses, radiation can increase the risk of cancer. The vast majority of patients who have X-rays taken will never get enough radiation to worry about cancer. Only patients who must have large numbers of X-rays-hundreds-over many years need to be concerned. This test has more risks associated with it than most. This is one reason that doctors prefer to use "noninvasive" tests first, such as the MRI and CT scan.
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Electromyography and Nerve Conduction
Electrodiagnostic consultation is usually performed by a neurologist. The electrodiagnostic examination is essentially a neuromuscular disease consultation with the addition of electrophysiologic testing. Electrophysiologic testing of the patient with low back or neck pain is indicated when one suspects a radiculopathy, peripheral neuropathy, spinal stenosis, or an entrapment neuropathy. It is particularly important with complaints of sensory (pain, numbness, tingling, or burning) or motor (weakness, "giving out", or fatigue) symptoms. The electrodiagnosic study can frequently identify the level or levels that are most involved in a radiculopathy. Likewise, electrodiagnosis can eliminate other diagnostic possibilities.
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Bone Densitometry
STOSSA offers the state of the art bone densitometry. Bone densitometry is a safe, painless X-ray technique that compares your bone density to the peak bone density that someone of your same sex and ethnicity should have reached at about age 20 to 25, when it is at it's highest. It is often performed in women at the time of menopause. Several types of bone densitometry are used today to detect bone loss in different areas of the body. Dual beam x-ray absorptiometry (DXA) is one of the most accurate methods.
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X - RAY
What is it?
An X-ray uses a radioactive beam to take pictures of bone. The beam is projected through your body onto a special film, just like a camera.
Why is it done?
An X-ray is good at showing bone. An X-ray is helpful if your doctor suspects a fracture of the spine, an infection, or a tumor. Doctors have used X-rays for over 100 years to check bone alignment and to see whether certain shadows appear to be out of alignment. This can give clues about the health of soft tissues around the spine. If your doctor thinks your problem may be from degeneration of the spine, X-rays can be used to see if the space between your vertebrae is decreased, if there are bone spurs, or hypertrophy (enlargement) of the facet joints.
How is it done?
Having an X-ray is much like having your photograph taken. It is a quick and painless procedure. You will be asked to lie very still on a table or stand very still and hold certain positions while pictures are taken of your spine. Sometimes X-rays are taken while you are in different positions. For example, an X-ray may be taken while you bend forward (flexion), and another while you straighten your spine (extension). This is called a "flexion-extension" view of the spine. These X-rays are compared to see if there is extra movement between the vertebrae, a condition called segmental instability.
What are the limitations?
X-rays are not good at showing the soft tissues-nerves, discs, and ligaments. Today many tests can show the soft tissues much clearer, so doctors do not always have to rely on X-rays. However, X-rays provide a good starting point in evaluating the spine.
What are the risks?
X-rays use radiation, which in large doses can increase the risks of cancer. The vast majority of patients who get X-rays will never get enough radiation to worry about cancer. Only patients who must have large numbers of X-rays-hundreds-over many years need to worry about this risk. Children, and young adults who plan to have children, should be protected from radiation exposure to the testicles and ovaries. The radiation may damage the sperm and eggs. It is simple to protect these areas by shielding them with a lead apron or lead blanket.
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MRI Scan and CT Scan
What is it?
Magnetic resonance imaging (MRI) is a fairly new test that does not use radiation. Rather, magnetic and radio waves are used to create computer-generated images. MRI pictures can scan multiple layers of the spine and show abnormalities of bones and soft tissues, such as nerves and ligaments. The MRI is probably the most commonly used to evaluate the spine.
Why is it done?
The MRI shows the spine in very clear detail, including information about the bones, ligaments, muscles, nerves and discs. It can show if there is a loss of water in the nucleus pulposus, which occurs in the earliest stage of disc degeneration. An MRI can be used to show facet joint arthritis, spinal stenosis (narrowing of the spinal canal), or a herniated disc (protrusion or rupture of the intervertebral disc). The test is useful for diagnosing any condition in which the anatomy of the spine and its soft tissues need to be seen clearly.
How is it done?
You will be asked to lie on a table that slides into a machine with a large, round tunnel. The machine's scanner takes many pictures that are watched and monitored by a technician. The MRI scanner is noisy. You might be offered headphones to listen to music while the scan is taking place. The tunnel that you lie in is narrow and may cause some patients to feel claustrophobic. You might be given a mild sedative to make the experience more tolerable. Newer MRI machines, called open MRI scanners, are sometimes more comfortable for patients who experience claustrophobia. The procedure takes 30-60 minutes.
What are the limitations?
There is little the MRI does not show. However, X-rays and CT scans have a role in adding helpful information in spine conditions that require them.
What are the risks?
There appear to be no known risks associated with exposure to the magnetic waves used during an MRI. These waves can cause problems however, if you have any metal objects in your body that could be attracted to the strong magnetic field. For example if you had any type of metal clips or implants used in a previous surgery, including a pacemaker, make sure to inform the technician. X-rays may be taken of your head before the test to verify there are no metal fragments in your eyes or brain that could move when the magnet is turned on.
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Epidural Steroid An injection of Cortisone is placed over the nerve sac and nerves to reduce the swelling and inflammation caused by compression of the bone or disc material. These injections may be done with just an anesthetic medicine to localize the source of pain or with a combination of anesthetic medicine and cortisone to treat the problem.
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Facet Injections
Facet Injections A combination of anesthetic or numbing medicine with a steroid is injected to help diminish pain. Facet injections may also be used to determine the source of pain. Sometimes the nerve to the joint is injected or numbed to determine if that is the source of pain. This test is called a Facet Nerve Block.
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Trigger Point Injections
A trigger point is a sensitive or irritable spot in the body that can be a main or associated source of pain conditions. Most often, these spots are found in muscle and its lining (fascia) and are called "myofascial" trigger points. They can also be located in skin, ligament, and tendon tissue. Trigger points can be causes for bands of pain radiating quite a distance from the actual trigger spot. Because of this "referred pain", trigger points can even mimic pinched nerves. Trigger points can arise as a result of strain or repetitive use injuries, stress and muscle tension conditions, or specific disorders such as herniated discs, pinched nerves, fractures, and surgical incision healing sites, to name only a few. A Trigger Point Injection is an anesthetic medication injected into the area that is painful (trigger point). It may relieve the pain that often accompanies a back or neck disorder. Trigger point injections have been found to be very effective in relieving pain and are best used in combination with home exercise, heat, cold and medication program.
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Spinetex Rehab
Education
Education is one of the most important parts of any effective treatment plan. Patients will be educated on good posture and how to move properly. Patients will be taught how to perform daily activities such as lifting and bending. Most importantly, patients will be taught how to deal with their limitations. Patients will learn home exercise techniques. It is the patients' responsibility to continue their own exercise and therapy programs once treatment has concluded with Spinetex.
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Pain Control Therapy
Pain control therapy can include heat, ice, and electrical stimulation.
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Soft tissue therapy
Soft tissue therapy involves movement exercises that target muscles, ligaments, and connecting tissue.
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Stabilization Techniques
Stabilization techniques are a combination of strengthening and body mechanics. Patients learn positions and posturing that will reduce pressure on their back. This type of therapy will help patients improve their range of motion and resume their normal activities.
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Exercise
Exercise is the best treatment for back and neck pain. Exercise programs are developed based on the physical capabilities of each patient. Spinetex has exercise equipment designed to assist back and neck pain patients. Patients are taught exercises to strengthen and improve movement. These exercises can be done at home or at their own gym following the conclusion of their treatment at Spinetex.
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Non Surgical Medical Treatment
Epidural Steroid
Diagnostic Tests