Laboratory Studies

Laboratory testing is helpful in screening for the differential diagnosis.

Obtain a complete blood cell (CBC) count to check for the patient's white blood cell count and hematocrit level to rule out other disorders such as infection or multiple myeloma. Obtain serum protein electrophoresis results to evaluate for multiple myeloma.
Obtain a Westergren sedimentation rate measurement and C-reactive protein level to assess for osteomyelitis and/or infection.

Imaging Studies

Imaging studies are essential for making a diagnosis of disc injury.^{[4, 9, 10]}

Radiography
- Should be the initial examination that is ordered
- Unable to distinguish actual disc herniation
- May identify disc calcification (seen with degenerative disease in older patients)
- May help to identify infectious or oncologic causes for the patient's pain
Magnetic resonance imaging (MRI)
- Both T1- and T2-weighted imaging are needed.^[11]
- Sensitive for identification of disc herniation
- T2-weighted images exaggerate findings.
- Identifies calcification by low signal in T1- and T2-weighted images.
- Can identify the bony inflammation that is seen with tumors/infection
Computed (CT) myelogram^[12]
- Has improved bony visualization compared with MRI
- Not as sensitive for disc sequestration/migration
- Invasive relative to MRI

Treatment & Management

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Author

Kambiz Hannani, MD Medical Director, Spine Specialty Institute

Kambiz Hannani, MD is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Clinical Professor of Orthopaedic Surgery and Sports Medicine, Michigan State University College of Human Medicine; Academic Chief of Orthopaedic Sports Medicine, Regional Director of Ambulatory Clinic Site, Sports Medicine Institute, Detroit Medical Center

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Detroit Academy of Orthopaedic Surgeons, International Association for Dance Medicine and Science, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, Michigan Orthopaedic Society, Michigan State Medical Society, Mid-America Orthopaedic Association

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Thoracic Disc Injuries Workup

Laboratory Studies

Imaging Studies

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