Are X-Rays Enough to Diagnose A Spine Injury?

These days, when someone suffers an injury or experiences pain in their spine, neck, back or joints, the default assumption is, “I’ll just get an X-ray, and that will tell me what’s wrong.” However, an X-ray is just one of several types of medical imaging doctors use to diagnose injuries or illness. Let’s talk a bit about X-rays, what they can and cannot see, and why it is a good to supplement your X-rays with other medical imaging, like an MRI.

In this Polaris Mythbuster, Dr. Christopher Tomaras debunks common myths about X-Rays and other medical imaging technology and share the reality behind those myths.

Christopher Tomaras, MD of Polaris Spine & Neurosurgery Center in Atlanta, Georgia.

The Differences Between X-rays and MRIs

An X-ray is actually a form of radiation — more specifically, it’s a powerful electromagnetic wave with a very short wavelength, which makes it capable of passing through objects impermeable to other forms of light. This property effectively allows us to “see” inside the human body by shooting X-rays at the area we wish to image. The X-ray was first discovered in 1895, making it the oldest form of internal imaging used in medicine.

In recent years, scientists have developed numerous other methods of taking images of the human body — methods that show more detail with little or no exposure to radiation. One of the most common types of imaging is Magnetic Resonance Imaging (MRI), a process that combines magnets and radio waves to generate detailed images of internal organs and tissues.

Using several types of imaging in combination helps us create a more complete picture of the patient.

Myth #1: An X-ray provides enough data for a definitive diagnosis.

Reality: In modern medicine, an X-ray gives an incomplete picture.

“X-ray is only the starting point for imaging,” says Dr. Christopher Tomaras, M.D., a spinal expert at Polaris Spine & Neurosurgery Center. “The gold standard, now, are MRIs. We do get X-rays, but that only gives you a general, overall idea of the patient’s anatomy. Soft tissue, discs, nerves, these are all better visualized with an MRI. You don’t see those on X-ray alone. An X-ray by itself would only be able to diagnose just a few certain pathologies.”

Why do patients have the misconception that an X-ray is all they need? Dr. Tomaras says it’s partially due to patients’ preconceived ideas about it, often reinforced by other medical practitioners. “Many of our patients have seen medical professionals who make a pretty aggressive diagnosis on X-ray alone. And a lot of patients feel that has given them their answer, when in fact it hasn’t.”

Takeaway: X-rays are helpful for providing an overview of problems, especially bone-related injuries — but they don’t show the whole picture.

Myth #2: MRI is an effective alternative to X-ray.

Reality: MRI reveals things X-rays can’t, and vice versa.

While MRIs can reveal more detail about soft tissues and organs than an X-ray, MRI does have its limitations, particularly with regard to patient motion.

“An MRI is taken with the patient lying flat,” explains Dr. Tomaras, “so that’s giving you a picture in that position. Well, some patients actually have instability, so their anatomy changes when they stand or sit. So most of the time, we also get “flexion extension” X-rays — “bending” X-rays, patients standing and bending forwards and backwards. These X-rays supplement the MRI because the MRI can only give you a certain view in one position.”

Takeaway: X-rays show the bones fairly well, as well as how the bones move and flex together. MRIs show more comprehensive tissue damage, but they don’t show discrepancies with motion. Combining an X-ray with an MRI gives us a more complete picture so we can make a more accurate diagnosis.

Why Polaris Spine & Neurosurgery Center?

To ensure that we give our patients the most accurate diagnoses possible, as well as develop a workable plan for care and treatment, our policy at Polaris is to get both an X-ray and an MRI for every patient who comes to us with back pain or injury issues.

Want to schedule an evaluation with one of our spine experts or learn more about our treatment philosophy? Call Polaris Spine and Neurosurgery Center at 404-256-2633 for an evaluation.


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