Back Problems That Don’t Show Up On An X-Ray

Category: Back Pain | Author: Stefano Sinicropi | Date: September 14, 2020

Spinal x-ray

When you think of a diagnostic imaging test, your mind first goes to an x-ray. It’s the most common imaging technique, and odds are you’ve undergone an x-ray if you’ve ever potentially fractured a bone in your body. While they can be an informative option for care providers, they aren’t always a perfect diagnostic option for certain back problems. In today’s blog, we take a closer look at what types of back pain wouldn’t show up on an x-ray, and why your doctor may skip an x-ray when you show up to their office with spinal discomfort.

Why Your Spine Specialist Isn’t Ordering An X-Ray

An x-ray sends radiation in the form of electromagnetic waves through our body, and as these waves pass through they are absorbed by different structures. Calcium in our bones absorbs the most radiation, which is why bones appear so prominently in x-rays. Fat and other soft tissues absorb less of these waves, meaning they often appear gray or faded on the x-ray image.

For this reason, x-rays are typically ordered when injury cause and symptom description suggest a person might be dealing with a spinal fracture or similar bone issue. This is most common when the cause of injury involves significant trauma to the area. For example, after a car accident, a heavy collision in sporting activities or following a fall, a spine specialist may order an x-ray to see if a fracture has occurred to any of the vertebrae in the spine. In most cases of trauma to the area, an x-ray can be a helpful diagnostic tool.

On the flip side, there are times when an x-ray may not be your best option. In situations where back pain develops without direct trauma to the area, it may be unlikely to get all the answers you seek by ordering an x-ray. If pain develops after bending, twisting or being in the same position for hours, you’re likely dealing with a muscle, ligament or similar soft tissue injury. These are the same soft tissues that do a poor job absorbing electromagnetic waves, so it would be hard to see problems with these areas via an x-ray. Instead, an MRI would likely be ordered.

Misdiagnosis & Overtreatment

Another reason why an x-ray may not be ordered based on your symptoms is because an x-ray can sometimes lead to misdiagnosis and overtreatment. If you’re a frequent reader of our blog, you’re probably aware that your spine undergoes natural degeneration as you age. An x-ray of an average 60-year-old individual would likely show degeneration in certain areas of the spine. This degeneration may not actually be the root cause of your pain, but because it is seen on an x-ray, your physician may try to treat this section of your spine when your underlying cause is actually rooted elsewhere. That’s not to say that an x-ray can’t help find potentially problematic spinal degeneration, but most spines actually look worse on imaging simply because this degeneration happens to all of us, and it can lead doctors to draw wrong conclusions about your back pain.

So if you are dealing with back pain and want to get to the bottom of it, set up an appointment with your general physician or spine specialist. They’ll conduct a physical examination, ask you about your symptoms and likely order an imaging test. After significant trauma, you’ll likely undergo an x-ray, and for suspected soft tissue injuries, an MRI might be your best bet. Each of these diagnostic tools can help doctors uncover different issues and allow them to develop a treatment plan suited to your individual needs.

For more information, or for help with your back pain, reach out to Dr. Sinicropi and his experienced medical team today.

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