X-Rays and Back Pain

This is a frequent comment I hear from my new patients. The story usually goes like this. ” I went to my doctor because my back was really hurting me. He took some x-rays and told me that I had arthritis and that was the cause of my pain.”

As a spine specialist there is some truth to that statement and then there is not. There are many causes of back pain. These include disc protrusions and herniations, pinched nerves, facet joint pain, arthritis, bone spurs, and pain from injuries to the ligaments, tendons and muscles. However, in the most of people with back pain alone, we never find out exactly what is causing the pain. That is usually fine, because the overwhelming majority of patients feel better within a few to several weeks even without medical attention.

One tool that a doctor has in trying to make a diagnosis of why your back hurts is an x-ray. X-rays are a great tool when you want to look at the bones and joints. It will tell you nothing about discs or nerves. It will give the doctor an idea about how much your spine has aged. It can also identify a fracture, possible infection or tumor or autoimmune disorder affecting the spine

Having arthritic changes does not imply arthritis. Arthritic changes are a normal part of aging and may not be associated with pain. There have been many medical studies that have tried to link these changes with back pain, but the strong connection was just not there. This is not to say that arthritic changes cannot cause pain, but determining that by x-ray alone is very difficult. Personally, I have patients with very arthritic spines on x-rays with almost no pain and others with virtually normal films but pain so bad they cannot get out of bed.

The “itis” part of arthritis implies in medical jargon that inflammation is present. An x-ray usually cannot determine that. However, MRI, blood studies, and/or a response to anti-inflammatory drugs such as cortisone or NSAIDS (i.e. Ibuprofen, Naprosyn) can help.