Endoscopic Spine Surgeon Dr. Kaixuan Liu with Atlantic Spine Center offers tips on tests that pinpoint causes of back pain, from top to bottom

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Diagnostic Tests for Lower, Middle and Upper Back Pain.

Dr. Kaixuan Liu

Diagnostic tests may vary somewhat depending on whether your pain is in the lower, middle or upper region. That’s because the causes of middle or upper back pain are sometimes quite different than problems that strike the lower back.

When your back hurts – whether the pain arises in the lower, middle or upper region – all you likely care about is figuring out the cause. Fortunately, a variety of proven diagnostic tests for back pain can often pinpoint the trigger, helping smooth the path toward effective back pain treatment, according to Kaixuan Liu, MD, PhD, founder of Atlantic Spine Center.

Certain elements of back pain are universal no matter which part of the spine hurts, Dr. Liu says. But diagnostic tests may vary somewhat depending on whether your pain is in the lower, middle or upper region. That’s because the causes of middle or upper back pain are sometimes quite different than problems that strike the lower back.

Lower back pain is exceedingly prevalent, with 8 in 10 adults in the United States suffering from it at some point in their lives, according to the National Institutes of Health. But middle and upper back pain aren’t as common for a very good reason: The bony vertebrae in those regions – between the neck and the bottom of the ribcage – don’t flex as much as vertebrae at the top and bottom ends of the spine, which enable us to move our heads and hips.

“Because the upper back area encompasses the torso and houses key organs such as the heart and lungs, back pain in this area also has a higher chance of stemming from a more serious condition,” Dr. Liu explains.

“Pain in the upper or middle back can also be vague, since it might be ‘referred’ to that area from another part of the upper body,” he adds. “Because of that, doctors may need to dig deeper with diagnostic tests to determine the true cause of back pain.”

Stepwise approach
Regardless of what area of your back hurts, getting to the bottom of it typically starts with a list of questions from your doctor. You will likely be expected to answer:

  • When the pain started
  • What you were doing when it began – such as lifting a heavy object
  • What makes the pain better or worse
  • If you’ve had the pain previously
  • If you’ve suffered any recent illnesses, including stomach bugs, urinary problems or pelvic pain

Once your doctor takes a comprehensive medical history, they will proceed to give you a thorough physical exam, Dr. Liu says. This workup typically includes:

  • Watching you walk on your heels, toes, and soles of your feet to look for signs of nerve damage
  • Testing your reflexes with a reflex hammer at your knees and ankles
  • Testing nerve and muscle strength by asking you to raise your legs while lying down
  • Assessing sensation in your legs using a sharp object
  • An abdominal, pelvic or rectal examination, depending on specific symptoms, to look for diseases that can trigger back pain with nerve damage

Imaging tests
Most back pain resolves on its own within 4 to 6 weeks, according to Dr. Liu. For that reason, imaging tests might not be done immediately – unless acute pain in your back signals problems such as major trauma or a condition that threatens nerve damage.

When your doctor decides to “peek inside” to see what’s causing your upper, middle or lower back pain, what diagnostic tests are used? Dr. Liu says they include:

  • X-rays: This old standby is limited in distinguishing causes of back pain, Dr. Liu notes, but may be useful to determine conditions such as the bone-thinning disease osteoporosis or various traumatic injuries.
  • Myelogram: This type of X-ray involves injecting a special dye into the spinal canal.
  • MRI: Using magnets to produce images, this diagnostic test can pinpoint certain serious problems around the spine, including infections, tumors or fractures.
  • CT: Computerized tomography, or CT, scans can show soft tissue problems such as ruptured discs, narrowing of the spinal canal, or tumors.

Aside from imaging tests, your doctor may also perform nerve conduction studies, which use electrodes to both stimulate nerves running to muscles and record the nerve’s electrical signals. Nerve conduction studies can detect nerve damage.

“If you’ve experienced lasting pain in your upper, middle or lower back, rest assured your doctor has plenty of diagnostic tests at their disposal to unearth the cause,” Dr. Liu says.

Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with several locations in NJ and NYC. https://www.atlanticspinecenter.com

Kaixuan Liu, MD, is a board-certified physician who is fellowship-trained in minimally invasive spine surgery at Atlantic Spine Center.

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Melissa Chefec
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