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By completing the two initial phases of the examination (subjective and objective
testing), the clinician should then be able to either confirm or refine his or her pre-
liminary diagnosis. If the preliminary diagnosis is refined, then subjective testing
should again be used in order to reach to new more accurate results. If the preliminary
diagnosis is confirmed, then the clinician advances to the next phase, which is the
assessment
.
2.4 Assessment Phase
Having reached to a preliminary diagnosis, this phase involves the evaluation of the
findings derived from the subjective and objective phases, especially concerning pain
epidemiology, and severity of pain [27]. At this point, the clinician can also determine
whether further imaging testing is needed to assist in the evaluation, or rule out clini-
cal suspicions that he/she might have, since as it has already been mentioned, due to
limitations of pain drawings and pain measurement tools, the results that would derive
from the subjective and objective phases might as well be vague.
Imaging Techniques.
There are various imaging techniques that could assist in the
diagnosis and assessment process, but they normally vary in purpose that they could
be used. So, [11] in his review outlines the following most common imaging tests:
X-rays.
This diagnostic test is considered to be fast, economical and convenient; how-
ever its use in the diagnosis and assessment of back pain does not yield any important
findings. Nevertheless, for specific cases it is a valuable tool to use [38].
Computerized Tomography (CT) Scanning.
CT scan is one of the most valuable tools
for assessment of back pain. It is also said to be really efficient in providing valuable
information regarding the bony architecture [39], and combined with plain X-rays, it
could be sufficient to provide enough data for back pain diagnosis and proposed
treatment [38].
Magnetic Resonance Imaging (MRI).
MRI scanning has almost become the gold stan-
dard in the assessment of patients suffering from back pain. Its advantage over CT
scanning is its ability to provide clear high-definition images of the soft tissues that
the bony architecture consists of, and the low radiation emission. However, draw-
backs of this technique also exist, including its cost and complexity of use [38], [11].
In overall, it is argued that CT and MRI scans are generally only helpful in evaluation
of patients for whom surgical procedure has been considered [55].
Discography.
Discography is considered to be an invasive technique with notable
risks in the assessment of back pain, as it normally involves the injection of contrast
material in the disc area, something that usually cause low back pain [11]. Consecu-
tively, there has been a lot of controversy in literature about its use in the assessment
process, with most of the current literature supporting the use of discography in spe-
cific situations, as cited in [38]. Similarly to MRI, discography should be considered
to patients undergoing a surgical procedure.
Ultrasound imaging.
According to [11], ultrasound imaging is a flexible technique
used to assess the pathogenic disc. In studies that have been conducted, it was found
to be able to detect changes in the pathogenic area; however it was not considered
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