The following are some of the most frequently performed diagnostic tests used by our
physicians. Since each of these tests may have risks associated with them, you should discuss
them with your physician
An x-ray will show the bones of the spine and/or skull. It can help determine if there has
been significant wear and tear or other disease of the bone. It will also show whether the bones
are lined up properly or if discs may have degenerated. In addition, it shows bony spurs, which
may irritate nerve roots. This test takes about five minutes to complete.
This test helps identify which discs in the spinal column may be damaged and cause pain. The
test requires the placement of a needle into the spaces between discs under x-ray guidance,
after which a “dye” is injected. A CT scan is then performed. Following the CT scan, patients
are taken to a recovery area and monitored for about 30 to 60 minutes. The doctor also may
prescribe pain medication that may reduce any muscle discomfort following this procedure.
Computed Tomography (CT)
CT scans provide anatomical information about the status of organs. A CT (also known as a CAT
scan) uses an x-ray beam to produce a two-dimensional, computerized map of the body. The x-ray
beams in a CT scan are able to detect density, including bone density. Neurological CT scans
focus mainly on the head or spine, providing valuable diagnostic data about cranial and spinal
injuries or disorders.
Epidural Steroid Injection (ESI)
An epidural steroid injection is used to relieve pain at the nerve root and decrease
inflammation. They are effective in the treatment of bulging or herniated discs. Injections are
administered by anesthesiologists and are a combination of a short acting steroid (anti
inflammatory) and a local anesthetic. ESI’s are performed under fluoroscopy with a local
anesthetic under the direction of an anesthesiologist.
The myelogram is an x-ray with a special dye that highlights the spinal cord and nerve roots.
After the skin is locally anesthetized, dye is usually injected into the spinal fluid in the
lower back with a needle and x-rays are obtained. A CT scan follows. The test takes
approximately 30 minutes to complete.
Magnetic Resonance Imaging (MRI) / Magnetic Resonance Angiography (MRA)
An MRI measures the health of cells and how well they are functioning. The test uses a
magnetic field that shows in great detail the brain and spinal cord. The MRI scan can be
critical to planning surgery, radiation therapy, treatment for stroke, or other interventions to
treat brain and spinal disorders. It is extremely useful in identifying stenosis (narrowing of
the spinal canal) and herniated discs. The MRA studies blood vessels in the neck and brain,
helping to detect abnormalities. The MRI and MRA can be used to identify and monitor a number of
neurological injuries and disorders, including tumors of the brain and spinal cord; chronic
disorders of the nervous system such as multiple sclerosis; stroke and other diseases.
An angiogram can be used to evaluate arteries and veins of the head, neck, brain and
occasionally the spinal column. During this test, a series of regular x-rays are taken after a
dye is injected directly into an artery. It is often used to determine the degree of narrowing
of an artery in the head or neck and to detect the location and size of aneurysms and vascular
malformations. This test usually requires a doctor to insert a catheter into the major artery
near the groin and then direct it upward to the arteries near the brain. The test may take 15-30
minutes or longer, in addition to several hours of observation afterwards.
An EMG tests the electrical impulses traveling between the brain and spinal cord and the
affected area. If that electrical impulse is blocked somewhere along the spinal pathway, it may
be slowed down or decreased in size as it travels to its final destination (skin, muscle,
fingertips, etc.). Therefore, abnormal function may indicate that there is nerve injury or
muscle dysfunction. During this test, the doctor places very thin needles into the muscles to
record the electrical signal from the various leg or arm muscles. This test takes about 20-30
Nerve Conduction Velocity (NCV)
NCV utilizes electrical stimulation of a specific nerve or nerves and then records the
nerve’s ability to transmit an impulse or function normally. During this test, electrode patches
are placed along the identified course of the nerve. The nerve is then stimulated in one area
with a tiny electrical current. A nerve will transmit the signal along its course so that an
electrode placed further down the arm or leg captures the signal as it passes. The results of
this test are usually compared with the results from the EMG test, allowing the doctor to
identify which nerves are affected and the degree of malfunction or damage. This test takes
approximately 15 minutes per extremity.
Nerve Root Block (NRB)
Nerve roots exit the spinal cord and then come together to form nerves that travel into the
arms or legs. These nerves allow movement and sensation of the arms, chest wall and legs. This
test provides important information about which nerve is causing pain by temporarily numbing a
specific nerve root. If the patient’s pain is reduced after the injection, that nerve may be
causing the pain. By confirming or eliminating the source of pain, the test allows the physician
to develop appropriate treatment, which could include further nerve blocks and/or surgery. This
test takes approximately 15-30 minutes to complete for one nerve, plus 90 minutes of
observation; testing additional nerves requires extra time.