Q & A  #2 | Q & A  #3 | Q & A  #4 | Q & A  #5 | About S.E.D.

WHAT ARE THE CAUSES OF LOW BACK PAIN?

Back pain is a generic term  for the pain experienced by the patient.  It really cannot be quantified.  However, there are many causes of lower back pain.  The lumbar spine is made up of five vertebral bodies.  They are joined together by ligaments, which connect the bone to the bone.  Sometimes these ligaments can tear, through chronic attrition or trauma.  The ligaments have small nerves that supply sensation to them. In addition to the ligaments, there are two small joints that connect the vertebral bodies together.  These are called facet joints.  Facet joints give you the ability to bend forward and sideways.  These joints are also supplied by small nerves.  Microtrauma to your lower back can also cause this joint to become painful.  Lower back pain can also be produced by the disc. The disc is what separates the lumbar vertebral bodies.  The disc can become damaged in many different ways.  The outer aspect of the disc is called the annulus.  The annulus is made up of proteins and water.  It is richly supplied by nerves, and can reproduce back pain.

MY FRIEND HAD KIDNEY STONES.  HOW DO KIDNEY STONES PRODUCE BACK PAIN?

Organs in the body, such as the Kidney, Liver, Spleen, Pancreas, etc., are all connected by the nervous system.  When an organ is injured, the nerves supplying these important structures send messages through to the brain.  The connection is the spinal cord.  The spinal cord runs through a large hole in the center of the vertebral  body.  Back pain is thusly produced.  Another way that pain is produced is through the enveloping fascia.  Fascia is the envelope over all the organs.  It is like a hard tissue pain; strong and absorbent.  The major organs including the heart and the lungs are all covered by this stuff.  When the fascia is irritated in one area, the other areas are affected.  Imagine sitting in a car and getting rear ended hard.  Lets say there is not too much rear end bumper damage.  Nevertheless, you as the driver will feel the impact and be shifted.  This is just like the fascia that covers the organ in the front of the body; when that is irritated the back muscles will feel the problem as well.  Kidney stones produce both nerve pain, through the ureter where the stone is stuck, and through the fascia or the surrounding envelope.

MY BACK MUSCLES ARE ALWAYS TIGHT, WHY?

The lower lumbar spine is surrounded by muscles.  There are small muscles which go up and down along the spine, they are called paravertebral muscles. A very important muscle that is situated deep into the front of your belly is called the Psoas (pronounced “So As”, the “P” is silent).  Believe it or not this muscle causes us to be able to lift our hip upwards.  The abdominal muscles are the more superficial ones in the front of our belly.  Of course all these muscles are enveloped by fascia.  Remember that is the covering of all the organs as well.  Tightness of your lower back may be due to muscle stiffness.  The muscles are contracting, or always working to keep you upright.  Also the fascia can also be contracted, making it difficult for your muscles to expand.

WHY SHOULD I CHOOSE ENDOSCOPIC SURGERY OVER OTHER PROCEDURES?

Endoscopy is a less invasive procedure.  It is called Selective Endoscopic Surgery.  The surgery “selectively” removes only the damaged disc material, leaving the good disc alone.  The indications for the surgery are a damaged annulus and an actual herniation of disc material. The standard open procedure is performed with a larger cut in the back.  After the skin is incised muscles have to be stripped away from their origin to gain access to the spine.  Then bone and ligaments have to be chiseled away in order to gain access to the disc. Endoscopy (using to YESS technique), however, simply requires a small cut in the skin.  There is no cutting of the bones or ligaments to gain access to the disc. Muscles are not stripped away and there is minimal bleeding.

DURING  THE ENDOSCOPIC SURGERY HOW DO YOU KNOW WHICH IS THE GOOD DISC AND WHICH IS THE DAMAGED DISC TO BE REMOVED?

Normal disc is white.  Endoscopic surgery is performed after a small needle is placed into the center of the disc.  A blue dye is injected  into the center of the disc.  This stains only the damaged disc.  Normal disc will not uptake the stain.  Once the endoscope is placed into the disc, the endoscopist will see blue stained disc material which needs to be removed or debrided.

IF THAT IS THE CASE THEN HOW DO SURGEONS WHO PERFORM BACK SURGERY WITHOUT THE ENDOSCOPE KNOW THEY ARE TAKING OUT BAD DISC?

Back surgery is still being performed by the majority of surgeons without the endoscope.  There are various techniques, but I call them all “open back surgery”  OBS.  It requires stripping the muscles, cutting away important ligaments, and chiseling bone, to gain access to the disc.  OBS cannot distinguish between normal and abnormal disc.   It is a non-selective surgery.   Therefore, the surgeon will explore the entire disc and remove as much as possible. Certainly  if the surgeon would stain the disc with the blue dye, the abnormal disc would be removed and the good disc would stay.  However, the blue dye will also escape form the disc.  Because OBS opens the entire spine, the blue dye would escape its contents and stain the muscles and bone blue.  The disc would be too dark to see vital structures. During endoscopy, the blue dye does not escape because there is only a tiny opening into the disc.  Also, the light source is of high intensity from the endoscope.  It gives great visualization of all the structures.

ARE THERE ANY INDICATIONS FOR AN OPEN BACK SURGERY  NOT SELECTIVE ENDOSCOPIC SURGERY?

Yes.  If there is a lot of bone that needs to be cut away from the nerve.  Selective endoscopic surgery can remove small amounts of bone if needed.  This is performed with  a laser directly visualizing the bone.

Q & A #2
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WHO IS A CANDIDATE FOR MINIMALLY INVASIVE ENDOSCOPIC SURGERY?

Those who possess the following symptoms:

-          radiation of leg pain either right, left, or both aggravated by sitting or walking

-          weakness in lifting the toe or heel with leg pain

-          numbness or tingling in either legs

-          back pain with radiation into the buttock muscles

-          inability to straighten up

-          numbness into the side of the leg or foot

-          pain into the testicles or down the front of the leg

WHAT TESTS SUGGEST THAT I MAY BE IN NEED OF A MINIMALLY INVASIVE SPINE SURGERY?

After your physician has examined you, there are numerous tests that confirm your problem:

-an absent reflex

-a positive straight leg raise test

-atrophy of a muscle in the leg

-inability to raise the big toe or heel walk

-a positive MRI scan for a disc herniation or degenerative state

DO I NEED TO GO IMMEDIATELY TO SURGERY IF THE TESTS ARE POSITIVE?

No.  For example, I had a middle aged patient who as a child had a club foot.  He had atrophy of the leg and weakness into the calf muscles. These signs may not have been  from the disc problem, rather the foot problem as a young child. Therefore your physician must thoroughly exam you.  A complete history must be taken.  After your physician exams you then surgery may be an option.  However lets look at the alternatives to surgical intervention.

-epidural: this is where a needle is placed into your epidural space.  The epidural space is an empty covering surrounding  the disc and the nerves running into your legs. A steroid is injected in the sac.  The steroid is meant to reduce the inflammation around the nerve. 

-physical therapy:  this includes  traction, electrical stimulation, galvanic stimulation, ultrasound, and manual stretching.  The purpose of course is to reduce the swelling around the nerves by having the muscles function better. Patients with back problems generally have weak abdominal muscles.  The front muscles are the support muscles of the lumbar spine.

-sacroiliac joint injections:  sometimes the patient’s pain is not in the back.  Rather the large pelvic joints (2) that support the lumbar spine and attach it with ligaments to the pelvis, may be torqued or twisted.  This type of joint pain can mimic the pain produced by a disc problem.  Sometimes, a simple injection into the joint with a steroid will silence the problem.

-osteopathic manipulation:  according to an article published a few years ago in the New England Journal of Medicine, osteopathic manipulation proved as effective as medication in a certain population of back pain.  Manipulation resets the articular facet joints.  Remember these small joints support the vertebral bodies and are connected by ligaments.  The facet joints allow us to turn and twist.  They are supplied by small nerves. There are other specialties that perform manipulation.  Manipulation includes, soft tissue palpation and release, massage, and articulation of the joints.

-medications: although a mainstay in American Medicine, medications are not without side effects.  I was taught in my osteopathic medical training to be cautious with giving out pills.  However a trial of medications will sometimes help reduce the inflammation.  I have had success with anti-inflammatory medications, certain muscle relaxers, and narcotics. 

-deep tissue massage: perhaps two years ago I would have placed this under the category of physical therapy.  Deep tissue massage has come into it’s own.  The foundation is that the same as the osteopathic approach; reduce the swelling around the damaged tissue by helping the body rid itself of the pain mediators in the area.  As the saying goes, “Try it, you’ll like it.”

-acupuncture: certainly an option for chronic pain. I am not an expert on how it works.  But future writings will include a more detailed explanation.

IS THERE ANYTHING I THE PATIENT CAN DO TO REDUCE MY BACK PAIN?

Yes,  as my mother always  reminded me to sit up straight.  But it really isn’t that simple. 

-quit cigarettes.: Yes I know as a doctor I am supposed to tell you that otherwise I guess I wouldn’t be a good doctor.  But cigarettes have chemicals that suppress the blood flow to the disc.  I have found in my practice of medicine, that those patients who smoke regularly have a tougher time recovering from injury.  This is not a published study.  Smoking also increases the chance of post operative recovery from a general anesthesia.  Since the smoke causes a reduction in the lung capacity, oxygen that is needed in the body has more problems getting there.

-stop running:  Yes you heard me. How can a fellowship trained orthopedic surgeon be telling his patients to stop running.  If your back pain is due to arthritis or disc deterioration, the constant pounding of the pavement will damage the vertebral discs.    (This is meant of course for those who have back pain.)  Keep in mind that your bones have the capability of transmitting vibration.  One surgeon I know was able to tell if his patients had a fracture by putting a tuning fork near the end of the bone, and then listening with a stethoscope to see if it was transmitting. ( Personally, I’d rather have my bone x-rayed). For those who run, without back pain, follow the adage : “If it aint broken, don’t fix it.” In other words keep running.

-eat the right foods.  Yes mother, I ate all my oatmeal.  Believe it or not, the federal government has actually agreed with mothers (and doctors) on what to eat.  Fresh fruits and vegetables have the Vitamin C, E, and B complex needed by bones and nerves to function properly.  Two helpings three times per day are what is correctly recommended.  Additionally minerals such as Magnesium and Calcium are needed.  Before you run out and buy all those pills, try eating a balanced diet and stay away from the fried foods.

-keep your weight down: gravity does funny things to us as we age (except of course if your hair belonged to Albert Einstein). The lumbar spine is prone to increase its curvature as we get older. This lordosis will put more pressure on the nerves coming out of the back.  Your front abdominal muscles also weakens, and contributes to the problem.

Q & A #3

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WHAT IS ACTUALLY INVOLVED IN THE PROCESS OF SELECTIVE ENDOSCOPIC SURGERY?

First an evocative discogram then the discectomy.

The evocative discogram is the first step.  I carefully place a needle into the disc space.  After that part is performed, I inject a radio-opaque contrast dye into the disc.  The contrast contains ISOVUE a tradename for an iodine based agent.  The iodine based agent shows darkness when injected on the x-ray.  The pattern made by the dye into the disc allows me to see a certain pattern, telling me how badly the disc is damaged.  If the disc is bad, the patient will feel some discomfort during the injection.  This is the evocative portion.  If the disc is normal, the patient will feel nothing.  Normal discs do not hurt.

The discectomy section of the procedure requires instrumentation place into the disc, using the needle as a guide. The endoscope is a 7 mm in diameter.  I am able to directly visualize what is inside or around the disc.  I am also able to  work through the endoscope.  This is a feature that I have using the YESS technique.  Most endoscopy procedures are blind: You cannot visualize exactly what you are doing.  The YESS technique, however, allows the surgeon to see everything he is doing.  The endoscope also has many different portals.  A continuous flow of an isotonic solution of saline and antibiotic are flushed into the disc space during the procedure. 

WHAT DO YOU MEAN BY SAYING: SELECTIVE ENDOSCOPIC SURGERY?

Selective in Selective Endoscopic Surgery means I am selecting only the damaged disc to treat.  During the evocative discogram, in addition to adding the radio-opaque contrast agent, I also add isocarbine, a dye that is taken up by only the damaged disc.  Studies have shown that the acidity of damaged disc tissue attracts the contrast agent.  The normal disc does not uptake the contrast material.  The dye is safe around nerve tissue and muscles.  It is water soluble and flushed out during the procedure.

When I perform the surgery, the damaged disc is blue, and the good disc white.  I only remove the damaged.  In contrast, an open back surgery, all the disc, good or bad is removed.

BY REMOVING THE DISC, CAN YOU REPLACE IT WITH ANYTHING?

The damaged disc is removed.  So far there is nothing FDA approved as replacement disc.  The disc is “regenerated” with the body’s own fibrous tissue.  Additionally, minimally invasive surgery does not remove the normal supporting disc.  The supporting disc allows the vertebral bodies not to collapse onto itself.  In an open back surgery, since all the disc is removed, collapse of the vertebral bodies is eminent.

WHAT HAPPENED TO THE STUFF THAT DISSOLVED DISC?

Chymopapain.  It is an enzyme found in such fruits as Papaya.  It is also a meat tenderizer.  This substance works by dissolving the damaged disc.  However in the 1980’s there were a few misguided needles placed into the back.  Contact was made with the nerve, and a few patients never walked again.   The 1980’s chymopapain had a quality assurance issue as well.  The Swedish manufacturer made the substance too weak .  Therefore it failed. 

With Minimally Invasive Endoscopic Surgery, the surgeon knows exactly where he is at all times.  This is confirmed by x-ray, visualized through the endoscope, and felt by various inta discal probes.  Chymopapain works.  The manufacturer has changed.  However, it is expensive and difficult to find.  Because of newer advances with the endoscope, chymopapain would be safe and effective.

ARTHROSCOPE VERSUS ENDOSCOPE?

Actually Endoscopic Surgery could also be Arthroscopic Surgery.  The Latin root for Arthro is joint.  Technically stated by my anatomists colleagues the vertebral bodies separated by the disc is a joint.  So in essence Selective Endoscopic Surgery should be Selective Arthroscopic Surgery.  Right? Wrong.  Arthroscopes are generally shorter and of smaller diameter.  The Knee arthroscope has a diameter of 4 mm.  The wrist and the elbow arthroscope have a diameter of 3mm.  The lumbar spine “arthroscope” has a diameter of 7mm.   The endoscope offers the surgeons more portals to do something with.  For example, because of the larger size of the endoscope, I am able to place probes and instruments directly through the instrument.  However with the arthroscope a separate portal of entry must be made.  The Endoscope allows me to have a suction device and water inflow running through the scope.  The Arthroscope only allows me one or the other, but not both.  The endoscope is much longer.  The light source much brighter.  However, one thing is majorly in common:  To  learn how to perform Minimally Invasive Endoscopic Surgery, the surgeon must be able to have mastered the arthroscope.  This is the reason why many “spine” surgeons are not qualified to perform Minimally Invasive Endoscopic Surgery.

WHAT IS THE PURPOSE OF THE WATER RUNNING THROUGH THE ENDOSCOPE?

A continuous saline solution made up of isotonic water and antibiotics serves two major purposes:

1.   It is the medium for the surgeon to see the anatomical structures.  Light travels through water differently than through dry air.  Just try swimming in a murky pool.  After your first dive, place goggles on.  You will see a world of difference.

2.   The fluid flushes out damaged  tissue metabolites that mediate pain.  (See next question).

DAMAGED METABOLITES --- IS THAT SOME KIND OF NEW DIET OR SOMETHING?

I suppose it could be.  Whoever reads this, remember site your source.  When tissue, any tissue is damaged it becomes acidic. Additionally the tissue excretes prostoglandins, histamines, substance X, and other abrasive chemicals to assist the body in healing.  Unfortunately, as usual, too much is not such a good thing.  These metabolites inflame nerve tissue which send signals to the brain, that there are problems in paradise.  The brain sends more signals, which end up ultimately telling the person (host), “PAIN”.  The host  is supposed to stop what he/she is doing to stop aggravating the structures producing the chemicals from the damaged tissue.  However, somewhere in ancient literature since cave days a hieroglyphic was found and printed:  &*^%$#)(*&###@.  Translated this means, “NO PAIN NO GAIN.”

Damaged tissue propagates damaged tissue.  It compiles on itself algorithmically. (2,4,16,32…) 

Pain specialists are now better understanding pain cycles.  In the real life illustrations, I show “inflammatory membrane” of what these substances do to tissue.  Theoretically, we should be able to stop the pain mediators from doing what they are doing. 

IS THIS LASER SURGERY?

No.  If you want to see laser effects go to the Disneyland Hotel.  They have a nice laser light show. 

THEN HOW IS LASER USED IN THE SURGERY?

That’s more like it.  Let’s start at the very beginning.  Laser means light amplification by stimulated emission of radiation .  What does that exactly mean?  Light is a genera soft wave form.  With help from some highly charged particles, light packets melt together and form a strong, straight, coherent form.  This new form of light energy is compact .  This is what laser is: a high energy form of light. In surgery we take advantage of this form of light by using it to vaporize damaged tissue.  It is highly effective at eliminating damage.  Laser energy metaphorically speaking can peel the banana without injuring the fruit.  In Endoscopic Surgery, I use the laser to remove the damaged tissue from the normal tissue.  I also use it to trim away arthritic spurs to give the nerve more room to navigate.  Laser is used to shrink tissue.  It is an essential part of the Endoscopic Surgery.

HOW COME I HAVE BACK AND LEG PAIN, BUT MY MRI DOES NOT SHOW ANY HERNIATION?

Discogenic pain comes from either a herniation, where it is impinging on the exiting or traversing nerves, or is fractured and not performing it’s function.

There are two essential parts of the disc:  The outer supportive annulus, and the inner mobile nucleus.  The outer annulus is the support, the foundation of the disc.  This is made up of protein and water.  Frequently, the annulus will fracture or tear.  It causes a release of metabolites.  It tries to heal itself.  And, through different non surgical modalities it may.  The MRI may not be sensitive enough to demonstrate annular disc tearing.  Sometimes, the MRI will show a darkened disc.  Radiologists often refer to this as a degenerative disc, for lack of a better term.  Endoscopically, the surgeon is able to see the actual tearing of the disc.  Tearing cannot be seen with the naked eye without amplification of the image on the endoscope.

The inner soft fluctuant nucleus is surrounded by the hard fibrous annulus. Imagine an acorn.  The inner seed is protected by the outer shell.  The seed is capable of moving inside the shell.  This is the same as the nucleus inside the annulus. The nucleus is always moving.  As you bend over, twist, or turn, the nucleus inside the annulus moves and supports the motion.  When the annulus cracks it allows a small opening for the nucleus to escape.  When that happens, the disc “herniates”.  This is called a herniated disc. The MRI is more sensitive to a herniation and will generally demonstrate this clearly.

WHAT ARE THE CHOICES BETWEEN ENDOSCOPIC SURGERY AND OPEN BACK SURGERY?

Minimally Invasive Surgery:

1.   Minimal scarring because bleeding during the procedure is less.

2.   Less chance of vertebral collapse after surgery, since only the damaged disc is removed.

3.   Overall a quicker recovery time, since muscle, ligament, and bone are not removed to gain    access to the disc.

4.   A more precise surgery, since visualization is enhanced.

5.   A better look at the traversing and exiting nerve roots.

6.   No general anesthesia.  Performed with the patient under sedation.

7.   Able to test all the discs.

Open back surgery:

1.   Patients with significant spinal sternosis, can remove bone easily.

2.   Lumbar Spine Fusions.

3.   Discs that have migrated midway up the canal (rare).

WHAT WILL MY REHABILITATION BE LIKE AFTER ENDOSCOPIC SURGERY?

Everybody responds differently.  Generally, the earlier the damage is fixed, the better the result and quicker the recovery.  However, should that not be the case, (and it usually isn’t with managed care doing whatever can be done to prolong the agony of patients), recovery times, I have found are quicker than open back surgeries.

Q & A #4

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Will I go back to work any quicker if I have a Minimally Invasive Spinal Surgery?

Each individual is different, however statistically patients that undergo minimally invasive spinal surgery get better faster than those who have the more invasive open spinal surgery .  Remember in the surgery the trauma to the surrounding tissues is minimized.  This means you are less likely to get a complication from this type of surgery.  Complications include epidural scarring, infection, instability, nerve dysfunction, etc.  There is no correlation between the type of work you do and the surgery itself.  For example:  If you are a diesel mechanic, and you have a back surgery of any type, the chance of going back to heavy lifting and work would be dependent on how much nerve damage there was, your bony architecture, and your ability to rehab the muscles.  Even though Minimally Invasive Spinal Surgery was performed, you still may have problems going back to your job.  Lets take another example:  Lets say you are school teacher.  Surgery was successful.  It does not mean you will be able to return to your previous way of teaching.  If it involves bending, stooping, squatting, or the like, you will probion is so important. 

So what you are saying is that work is not a consideration to the back surgery?

Everything is a consideration.  You need to keep in mind your work related actives.  These activities may have caused or exacerbated  the back injury. Therefore, returning to your work may cause your back to be re-injured.

Let's take another example of a man with a heart attack, we will call him George:   George has a major bypass operation.  He leaves the hospital on blood thinners, heart regulation medicine, and a strict new diet of no eggs and milk.  George goes back to work in the dairy industry as a cow milker.  He can’t stand it any longer and goes back to eating a lot of cheese, milk, and eggs.  George feels so well that he stops his medications.  Guess what, George died of a massive heart attack a few months later. 

You see, work may be the cause of the contribution to the problem. The way you work may have to be changed. Your lifestyle after any surgery may have to be changed.  Remember, doctors are not gods.  (That is something hard for medical students to understand).

Will my back pain ever go away after back surgery?  I mean that is what I have back surgery for, right?

A patient lets call him John, came to see me upset with his back surgeon.  He said, “You know doc, my back still hurts me, even after Dr. Zinger performed my surgery.”  I asked, “ What did Dr. Zinger say?”  John looked at me disgusted and replied, “He said, ‘I didn’t operate your back for back pain, I did it for the leg pain.’”  “Oh”, I said, “and what is the problem with that?”  John turned ever so slightly, wincing in pain, “I never had leg pain.” 

Back surgery is a misnomer.  You don’t operate on backs for just back pain because there is a higher chance of back surgery failing.    Back surgery is meant for leg and back problems.  Now it’s not to say back pain can never be operated on.  Its just it has a higher failure rate in the eyes of the patient.  Back pain can be caused from facet joint problems, annular disc tears, nerve root irritation, and instability.  By having one surgery, may not correct all the problems.

Q & A #5

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Is age a consideration regarding endoscopic surgery?

Certainly.  As we age, the nucleus of the disc dehydrates.  The annulus also cracks.  The facet joints may become arthritic.  The muscles weaken, and more stress is applied to the lumbar spine. Additionally, osteoporosis or softening of the bones occur.  Although, endoscopic surgery has been performed on patients greater than 60 years of age, the majority of patients are younger.  Disc herniations can occur at any age.  Disc tears also can occur at any age.  However, as we age treatment for the chronic pain becomes harder.

Are there complications that may occur with endoscopic surgery?

There isn’t any surgery which doesn’t have complications.  All the complications that could occur with endoscopic surgery  may occur with an open surgery. The most common complications of endoscopic surgery are:

Persistent nerve root pain: This may manifest itself as numbing or burning into the leg.  This may be due to manipulation of the nerve or the nerve regenerating.  As the nerve heals it will send sharp signal downward.  It may take up to one year before the numbness and the tingling cease.

Infection:  Infection may occur even without surgery.  However, any time one has an invasive procedure one must be prepared for infection.  Diabetics tend to have a harder time than most.  Obviously the  smaller the incision, the chances lessen.  Treatment of the infection is long term antibiotics, and a biopsy the tissue in order to obtain the organism to fight.

Leg weakness:  This too is transient and involves the nerve.  Sometimes after the disc is removed from the area, the leg muscle will get weaker for a short period of time.  This returns after 6 weeks.

Persistent back pain:  Remember no guarantees that any surgery will help resolve all the problems.

Headache:  Resolves usually within a day.  This is, I think, due to not eating prior to the operation.

Does outpatient surgery mean I can do more quicker?

No.  All outpatient means is that the surgery is usually done with you going home the same day. 

Why does the doctor insist I have x-rays taken of my back, when I already had and MRI?

An MRI gives information to the doctor regarding the soft tissue elements of the lumbar spine. However, the x-ray, which is really not an x-ray, but radiographs, demonstrate the  housing of the soft tissue.  Let’s take a step back and first discuss what is the actual difference between the two.  Radiographs are images produced when x-ray beams are excited and travel through your body.  White images appear as bone, and dark images appear as gas, or non reflective organs.  The x-ray beam was first realized by a German doctor, in the late 1800’s.  He discovered this accidentally, as most great discoveries are.  The beam was called an x-ray because of the mysterious of the wave.  An x-ray is actually part of the electromagnetic spectrum of  different wave forms such as light, microwave, and infrared.

The MRI, Magnetic Resonance Imaging, involves electrons.  Basically, (and very basic) a magnetic field is created and the excited electrons line up  your bodies magnetic field.  The computerized image demonstrates the organs of your body, and is weighted based on the excitation and recovery phase of the electrons.

Radiographs  together with an MRI give the doctor more information than just one or the other.  The radiographs allow the doctor to see how many vertebral bodies the patient has.  Although normally there are five vertebral bodies, many “normal” patients have four or six.  This would make a difference in the surgery, since those only relying on the MRI may not be able to tell which is the correct level to operate on.  Additionally the radiographs allow the doctor to see vertebral collapse, arthritis, bone tumors, and the alignment.

 The MRI allows the doctor to see the disc, relatively well.  As well as the disc in relation to the nerves.

However, what you must remember is the best way to treat is not off the MRI or the radiograph.  The best way to tell what a patient has is a good history and physical by the treating doctor.

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