The exact cause of back pain can be elusive. There is no single test that can definitively diagnose osteoarthritis of the spine.

A physician must perform a comprehensive evaluation and rule out other common causes of back pain such as a herniated disc and spondyloarthritis as well as less common causes, including infections, vertebral fractures, and abnormal growths (tumors).

Below is a description of the methods physicians use to make an accurate diagnosis.

Patient Interview and Physical Exam

    Patient interview. A doctor will ask a patient about family history and to describe the onset of his or her symptoms, the pattern of neck or back pain and stiffness and how symptoms affect lifestyle, as well as what makes the pain better or worse. A patient's reported symptoms are important for diagnosis and treatment. Before the doctor's appointment, it is often beneficial for a patient to keep a journal of symptoms and when they occur.

    Physical exam. A doctor will physically examine the patient's spine, noting what movements cause pain and specific pain points. The doctor will also evaluate strength, stiffness, and range of motion.

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Testing for Spinal Osteoarthritis

Follow up tests are usually included as part of the diagnostic process both to gain further information about the extent of the facet joint arthritis and/or to rule out other possible causes of the patient's pain.

    X-rays. An X-ray can show if there is a loss of joint space between the vertebrae, indicating a thinning of vertebral discs. An X-ray can also sometimes show bone spurs at a facet joint, a sign that the bones have tried to compensate for cartilage loss with extra bone growth. However, some people may have X-rays that show significant signs of spinal osteoarthritis but experience no pain, while others may have X-rays that show few signs of spinal osteoarthritis and have significant pain. Because of the high concentration of nerves radiating from the spine, even minor cartilage damage or bone spurs can translate into a lot of pain if either is in a sensitive spot. Therefore, the X-ray is just one tool to be used in conjunction with the patient interview and physical exam.

    CAT scan or MRI. Because of the spine's complex anatomy, doctors often need a more detailed image of the spine than an X-ray can provide. Magnetic Resonance Imaging (MRI) and Computerized Axial Tomography (CAT) scans both give doctors a cross-sectional view of the spine. These imaging technologies also show soft tissue (vertebral discs, ligaments, tendons and muscle) in addition to bone.

    Diagnostic injections. A doctor may inject local anesthetic into the joint or nerve that seems to be the source of pain and then observe how it affects the patient's pain levels. This procedure helps pinpoint the source of pain and can help rule out or confirm certain diagnoses. Diagnostic injections are typically done using fluoroscopy, which provides real-time X-ray images, and are performed by neuroradiologists, doctors who specializes in using imaging technology to diagnose and treat problems involving the head, neck, and spine.

    Lab tests. Lab tests cannot identify the presence of spinal osteoarthritis. Occasionally they may be used to rule out other less common causes of back pain, such as infection or malignancy. Lab tests may require a blood draw or an aspiration of the spinal fluid (sometimes called a spinal tap). Like diagnostic injections, aspirations of the spine are typically done by a neuroradiologist.

A comprehensive diagnostic approach is particularly important in light of the fact that most individuals over age 50 have some degree of osteoarthritis in their lumbar or cervical spines, but many have no symptoms.

Diagnostic studies (such as an X-ray or MRI) can help verify or disprove a diagnosis, but diagnostic studies alone, without a patient interview and physical exam, do not provide a conclusive diagnosis.

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