The spine wears out as it ages or after injury through a process called degeneration. This bones break, the disks collapse, bulge, tear and rupture and the joints thicken and swell. Some, all or none of these changes may be painful.
There bone, disk and joint abnormalities are found on x-rays, CT and MRI. X-ray shows an overview of the spine. X-rays show the bones best. They may show thickened bones, fractured bones, abnormal spinal alignment and increased spinal movements called instability. CT scan is similar to x-ray but gives finer detail and 3 dimensional perspectives. MRI scan visualizes soft tissues best like blood vessels, spinal cord, nerves much better then CT. It can show spinal cord compression and pinched nerves and fluid in joints. Unfortunately, these imaging studies only show the physical abnormality. They do not indicate if these changes are causing your pain.
To determine what abnormal structures are causing pain the patient may undergo pain mapping. Pain mapping is the injecting of medicine into or on the abnormal structure. If the pain is caused by the abnormality it will stop or decrease. If the pain does not improve then the pain is not from that structure, but is originating from something else, such as other bones, disks, ligaments, or spinal nerves.