individual muscle testing/motor examination of each upper and lower extremity
sensory function (light touch, pinprick, hot/cold)
deep tendon reflexes
pathologic upper motor neuron signs (Hoffman’s sign, clonus, Babinski sign)
pain elicited with provocative maneuvers (eg, straight leg raise, Spurling test)
Based on the pathology and the symptomatology, the following X-rays can be helpful:
Neutral AP and lateral
Standing 36” scoliosis X-rays
MRI is the gold standard for evaluating soft tissues, including intervertebral discs, nerves, the spinal cord, ligaments, and muscles.
In situations where patients cannot tolerate MRI scans, or it is not possible to obtain them due to a retained metallic object or a non-compatible device, myelography with X-ray or CT may be performed.
Neurophysiological diagnostic studies are helpful in situations where further clarity of the neurologic process and localization is required. These include electromyography (EMG) and nerve conduction studies.
These tests can help differentiate acute from chronic nerve issues and can also help localize the primary symptomatic nerve root in cases of multilevel disease.
Diagnostic and therapeutic blocks
Nonoperative strategies to help relieve pain and determine a symptomatic level can be accomplished with diagnostic and therapeutic blocks.
Under image guidance, epidural and transforaminal blocks can be performed with the injection of steroids and anesthetic medications to provide pain relief. They can also be diagnostic in determining the most symptomatic nerve root in cases of multilevel disease.