MRI scan: Magnetic Resonance Imaging is the most popular and often the best test for spine problems. No radiation is involved. Soft tissue shows up better than on CT. After prior surgery, an IV contrast injection can differentiate scar tissue from a herniated disc. Its drawbacks are claustrophobia, expense, and the need to hold still for a fairly long time.

CT scan: CT involves exposure to radiation, but can show better bone detail and sometimes shows small disc protrusions inside the nerve root canal not seen on MRI. The “hole in the donut” is larger, so claustrophobia is not a problem.

Open MRI/Stand-up MRI: The donut hole is large to avoid claustrophobia. However, the magnet is weaker and the pictures aren’t as clear. It’s also hard to get clear pictures standing or sitting because of body movement.

Myelography: Still a test that can show disc problems not seen on CT or MRI, because X-rays can be done in weight-bearing. It involves a spinal tap, so it is a little invasive. I usually don’t do one unless a patient really needs surgery and the CT/MRI was negative. Not all radiologists do a good myelogram because they don’t stand the patient up to get pictures in weight-bearing. Without that, it’s not much better than a CT scan.