A herniated disc could be the cause of mild to severe back pain.  The first step in determining the cause of back pain is to contact a doctor.  At this point, a doctor will perform an initial exam that will consist of a medical history and physical exam.

Initial Exam

After the medical history and physical exam are performed, a diagnosis of a possible herniated disc will be considered if there is irritation of one or more spinal nerves.   In this initial exam, if there is any loss of strength, sensation, or reflexes, the doctor will likely begin further investigation into determining if there is a herniated disc.  At this point, further tests and visits will be scheduled.  There will likely not be any more tests done during this visit.

Tests to Confirm a Herniated Disc

Imaging tests are used to confirm a herniated disc.   These tests are generally not performed unless nonsurgical treatments do not work to relieve the pain.  If there is still pain after four weeks of nonsurgical treatment, imaging tests will likely be recommended.   If the doctor is sure there is a herniated disc, these tests may not be needed.

Imaging Tests include:

• Magnetic Resonance Imaging (MRI) – This will confirm and show the location and severity of the herniated disc.  At this time, a doctor will look to make sure there is not some other serious condition, such an infection or tumor.   The images detailed in an MRI are of the soft tissues of the spine.  These soft tissues include:  muscles, spinal nerves, tendons, ligaments, discs, and marrow (the soft inner part of the bones of the spine).
• Computed Tomography (CT) Scan – This test will confirm and show the location and severity of the herniated disc, as well.  It can also look for other problems in the bones of the spine.  It can show detailed images of the bony structures of the spine.  This test is generally done if a person cannot have an MRI done.  For example, a person with a pacemaker cannot have an MRI performed.  It can also be performed if the results of an MRI are inconclusive.

For diagnosing a herniated disc in the lumbar spine (lower back), an MRI is preferred over a CT scan.  X-rays are not generally useful for diagnosing a herniated disc; however, a doctor may decide to have an X-ray or blood test done if there is no change in the pain after four weeks of nonsurgical treatment to rule out any other possibilities.

Other Test Options

The following tests can help to diagnose a herniated disc; however, they are not used as often for a herniated disc.  They could give the doctor more detailed information, if needed.

• Electromyogram and Nerve Conduction Test – Used to diagnose nerve and muscle disorder that could be performed on people who show signs of prolonged pressure on the nerve root.
• Myelogram – This is an X-ray of the spinal canal where a dye will outline the space of the spinal cord.  This test is combined with a CT scan and can be used if an MRI is not possible.
• Discography – In this test, a dye is injected into the gel-like center of the spinal disc to help diagnose disc problems.
• Nerve Root Block – A local anesthesia is injected next to the spinal nerve to confirm which nerve is being affected.

Once a doctor is certain of the diagnosis of a herniated disc, proper treatment options can be discussed.