Getting to the root of your spine problem, in my opinion, involves no short cuts. You should expect to fill out a pain diagram, a complete spine and medical history, get into a gown, (yes, the physician should LOOK at your back!) and have a comprehensive physical examination. Let’s start with a generic question: Where does it hurt? Some answers may surprise you. A patient may say that their tailbone hurts yet are actually referring to their lower back when asked to point to the area that hurts. Where is your tailbone? Where are your hips? How far up and how far down does the spine go? While these may seem like obvious questions, patients, especially pediatric patients, may give a variety of interesting answers since they may not know anatomy. When a patient tells a doctor, they hurt their tailbone (or another specific part of their body), it is ALWAYS helpful to make sure the physician and patient are talking about the same thing. It is important that the patient points to the place on their body where they feel pain or have been injured. Pain drawings are especially helpful as well. They illustrate what the patient feels and where on the body he feels it. There may be numerous imaging studies that may not be helpful or even indicated if the correct body part is not identified. Excess radiation can be harmful! Besides unnecessary x-rays, focusing on the wrong body part can delay treatment, send you to the wrong specialist and cost the patient time and money. Insurance costs will also be adversely affected. Patients – point to where you hurt! Your health could depend on it!
Then and only then, should your imaging be reviewed by your spine specialist. After that, the radiologist’s reports should be read. If any of these steps are skipped, or if any short cuts are taken, you are likely to be seeing a spine specialist who will be influenced before they see you. In general, we do not treat imaging, we treat patients. The history and exam will tell the treating physician how each patient is affected by their spine problem.
During the history we should focus on which body positions (i.e. sitting, standing, etc.) cause your symptoms to worsen or improve. This is helpful because you may have multiple imaging findings (i.e., disc herniations, stenosis, disc degeneration, and normal wear and tear). The only way to know what is symptomatic is to know which body positions cause your symptoms to worsen or improve.