In order for your back to be properly assessed you may be asked to undertake a variety of diagnostic tests. The most common tests used to diagnose back problems are X-rays and MRI scans.
An X-ray is a painless process that uses a low dose of radiation to take a picture of your spine. X-rays show bones, but not much soft tissue. Despite high quality scans, x-rays remain useful as they provide valuable information that is not readily available from MRI or CT scans, particularly when assessing spinal deformities and abnormal movement. These x-rays are often taken with the patient standing.
If required, an x-ray can be taken at the time of your appointment.
Magnetic Resonance Imaging (MRI) has revolutionized our understanding and treatment of the spine. MRI uses a powerful magnetic field and radio waves to create computer-generated images that allow us to see the spine in fine detail, enabling us to identify abnormalities of the soft tissues, such as the discs and the nerves. It is very useful for evaluating certain bony pathologies.
MRI is painless and does not involve any radiation. The only problem is the need to lie still inside, or at least partially inside, the large, cylindrical magnet where it can be a bit claustrophobic and noisy. An MRI scan normally takes about 30 minutes. It can be longer if more than one part of your spine needs to be scanned. Some patients have difficulty with having an MRI scan as they find it a very claustrophobic experience. If necessary, we can arrange for you to have your scan in an ‘open’ MRI scanner.
As a MR scanner is a large magnet, we have to make sure that there are no bits of metal in your soft tissues. We will also need to know about any recent surgery, any history of epileptic fits, if you have a pacemaker or other implanted cardiac device, of if you have hearing aids. We will ask that female patients confirm that they are not pregnant. You will be asked to fill in a pre-scanning questionnaire to ensure that there are no concerns.
You will normally be made an appointment for your MRI scan within a few days of your out-patient clinic appointment. If we are scanning one part of your body, for example your lower back, then the scan will normally take 25-30 minutes. You should expect to be at the hospital for no more than an hour. If you require more than one-part of your body to be scanned, then it will take longer. You can drive home after your scan.
Since the advent of MRI, CT scans have been used less in the evaluation of spinal problems. As with x-rays, CT is a process that uses radiation to take a picture of your spine. The dose of radiation though is much higher than with x-rays. CT is still used to assess 3D spinal anatomy (particularly when patients have a spinal deformity or other unusual anatomy) and to evaluate certain bony pathologies.
Some patients are unable to go into a MRI scanner as they have something in their body that would be at risk if exposed to a large magnet, such as a pacemaker, cerebral aneurysm clips, or a small piece of metal lodged in the eye. In these patients CT is sometimes used as an alternative to MRI.
You will normally be made an appointment for your CT scan within a few days of your out-patient clinic appointment. The scan will normally take 10-15 minutes. You should expect to be at the hospital for no more than an hour. You can drive home after your scan.
Isotope bone scan
An isotope bone scan is a method of looking at your bones to show conditions not seen using X-rays, MRI or CT or to further evaluate something that has been seen on previous imaging, such as a potentially suspicious lesion in the bones. It requires an injection of a small amount of radioactive fluid into your arm, which is then taken up by the bones. This scan is performed three hours after the injection.
Your scan will be performed with you sitting, standing or lying down. The camera will be brought close to various parts of your body and images taken. This will take approximately 45 minutes.
There are no ill-effects from the injection. The dose of radiation received from the injection is similar to 2 years’ worth of background radiation and is not considered dangerous. However, you should avoid prolonged contact with small children and pregnant women for 24 hours following the injection. You should keep yourself well hydrated for 24-hours following you scan and empty your bladder regularly. The radioactive material will be excreted from your body in your urine. You can drive home after your scan.
SPECT CT scan
A SPECT CT scan can be a useful scan in trying to look for a source of pain, that may not be obvious on other forms of imaging. It is essentially a combination of an isotope bone scan and a special CT scan which provides more accurate information about the anatomy and function of the area being scanned and makes it easier to identify problems.
The first part of the scan – the SPECT scan – involves injecting a radioactive fluid. Once completed you can leave the department, but you will have to return 3-4 hours later when you will have a series of special CT scans which can take approximately 1 hour.
SPECT CT scanners are not available in all hospitals. I normally arrange for these scans to be done at the Royal free Hospital, Hampstead. You will get more specific information on timings when the hospital contact you to make your appointment.
There are no ill-effects from the injection. However, you should avoid prolonged contact with small children and pregnant women for 24 hours following the injection. You should keep yourself well hydrated for 24-hours following you scan and empty your bladder regularly. The radioactive material will be excreted from your body in your urine. You can drive home after your scan.
An ultrasound scan is a procedure that uses high-frequency sound waves to create an image of part of the inside of the body. This image is displayed on a monitor while the scan is carried out. The scan is carried out by a Consultant Radiology doctor.
Whilst ultrasound is very commonly used in the assessment of unborn babies, it is also a valuable tool used in the assessment of musculoskeletal problems. We regularly request ultrasound scans to look at the soft tissues around the shoulder or hip, as well as in the evaluation of some lumps and swellings. If looking for shoulder or hip problems, then we may offer to carry out an injection at the time. This would be a targeted injection of a potent anti-inflammatory made up of cortisone steroid and a small amount of local anaesthetic. If we were planning for an injection, you will have been told about this beforehand.
You will normally be made an appointment for your ultrasound scan within a few days of your out-patient clinic appointment. The scan will normally take 25-30 minutes. You should expect to be at the hospital for no more than an hour. If you are having an injection then it would be sensible, though not mandatory, to bring someone with you who can drive you home afterwards.
This is a scan done to assess the density (strength) of your bones. If you have reduced bone density then this is what we call osteoporosis.
When you have a DEXA scan, you will lie on your back on a flat, open X-ray table. During the scan, a large scanning arm will be passed over your body to measure bone density in your skeleton using a low dose of x-rays. The areas normally assessed are your lower back and hips. The scan usually takes 10 to 20 minutes. You can drive home after your scan.
Nerve conduction studies
A nerve conduction study is a test on the nerves in the arms and hands. It can also be done on your legs. It is a test that measures how quickly messages are travelling along your nerves. The speed at which the nerves are working can give information about whether a nerve is trapped or damaged, and where the problem may be coming from.
To obtain measurements of your nerve impulses a recording electrode will be placed onto your skin, usually on your upper and/or lower limbs. Another electrode will be used to stimulate the nerve. The stimulator produces small electrical pulses which feel like a sharp tapping sensation. The process will be repeated for a number of different nerves. Although the test can be uncomfortable, and some people experience a slight increase in their usual symptoms for a few minutes afterwards, the test will not cause you any harm.
Sometimes we also carry out a second test called EMG studies. EMG studies assess the electrical activity of the muscles. This is usually recorded using a small needle electrode inserted through the skin into the muscle, which produces a short pinprick sensation. Once in place the activity in the muscle can be observed at rest and then whilst being used.
Please advise us beforehand if you are taking any blood thinning medication or if you have a pacemaker.
The appointment will last about 45 minutes and you can drive home afterwards.
What Patients Say
I would like to express my sincere thanks and gratitude for curing my pain. For months I have suffered in agony day and night. I was in despair and you were my last hope. Now I am not in pain! I am continually smiling and enjoying life again! March 2020
Mr Langdon was great from start to finish. I know that he saw me at the end of an already full clinic and on top of that arranged an immediate MRI…making him much later than he needed to be in getting home! I was in a great deal of pain and I very much appreciated his help in getting me sorted as fast as possible. He made sure I was early on in the running order of procedures on the day of my treatment and everything was explained well to me both before and afterwards. Cannot fault in any way. Thank you very much.
Very patient took his time explaining the surgery and aftercare. Very knowledge about my condition. Made me feel relaxed and in safe hands as I was very scared of the surgery itself and the possible risks.
Very caring, explained fully what was wrong and what he was going to do. December 2019
He was very professional and helpful before, during and after my minor treatment. December 2019
Mr Langdon was extremely helpful and reassuring. December 2019
Mr Langdon was clear and confident with his communication. This is reassuring for a patient. December 2019
Professional and treated to a high standard. Mr Langdon was excellent, he knew everything on my condition explaining all the options available. December 2019
Mr Langdon’s manner was very polite, professional and efficient, he answered all her questions and came to see her quickly after her epidural. June 2017
I have just completed a 102 mile walk over 7 days. Thank you so much for patching me up and making this experience possible. June 2017
Thank you for your specialist surgical and operational skills as well as your patient friendly approach. The two don’t always go together. We need people like you to maintain such high standards of surgery and care. October 2017
I wanted to take the opportunity to thank you and your team following my surgery. It has been so long since I felt so well and without pain. The surgery and my recuperation has far surpassed my expectations and has made a huge difference to my lifestyle. December 2017
Three months on from my back operation and I am feeling so much better. Thank you for all the kindness and support you showed when I was in such desperate pain. February 2018
Thank you so much for the work that you have done. What an incredible job you have and do. Life changing. March 2018
Thank you for all you have done for me during the last few weeks. I am most grateful not only for the main work but also the extras like telephoning to keep me informed. April 2018
I cannot thank you enough for the success of my back operation. Everyone was so pessimistic and you were so positive. May 2018
I was at all times given all necessary information, listened to, and I had confidence that Mr Langdon would complete the operation successfully. August 2018
Highly skilled and intuitive. October 2018
He was brilliant, I felt so comfortable that he would look after me even though I felt so anxious, and he made sure to give me all the information I needed. Also, every nurse and employee of Spire had nothing but brilliant things to say about Mr Langdon – I didn’t even need to ask. They would look on my notes and see I had Mr Langdon and say I was in excellent hands, and so I felt extremely happy. My partner also has disc problems so I will very much be pointing him to Mr Langdon October 2018
Very understanding and caring chap from start to finish, and a great bedside manner, unusual for some consultants. He is trying hard to understand my problems and working with me on a treatment plan for the present, and the future. November 2018
My consultant is obviously a very competent person and comes across as such. My procedure was fully explained both before and after my surgery. He also has a professional sense of humour, which helped as I was very nervous November 2018
Mr Langdon was always prepared to fully explain what was wrong and what he could do about it, he gave me a lot of confidence to make the decision to operate, and so far so good. Albeit early days. November 2018
Mr Langdon was very professional and helpful, he came in on his day off because my treatment had to be moved. November 2018
Excellent, extremely knowledgeable on his speciality. I managed to get an appointment to see him at very short notice for which I was very grateful. December 2018
Excellent surgeon, great manner, explained procedure well. December 2018
A good sense of humour, understanding and non-judgmental. They explained everything very clearly. January 2019
Mr Langdon, very professional and calm, did not push the treatment on me which I really liked, but advised and let me make up my own mind. January 2019
James Langdon is a really good person to have on your side. He’s smart, attentive and very dedicated. January 2019
I felt very safe with Mr Langdon, he fully explained the procedure, the risks and the recovery. January 2019
A very professional consultant. Showed great care and understood me as a person and patient. Saw me pre procedure and after in recovery room and own room. Visited again before going home in late evening and yet again first thing the next morning. It felt like I was Mr Langdon’s only patient which I know is far from the truth. Unfortunately, I am a nervous patient but could not have been in better hands. Many thanks January 2019
Explained everything in detail, understood my concerns, excellent bedside manner, very professional. January 2019
James Langdon is very patient – he answers questions and really listens to you and explains again if you haven’t quite got something. March 2019
Mr James Langdon was in every way, courteous, clearly good at his particular area of expertise, took time out every day to see me and check that all was ok. Was happy to answer any questions I had. April 2019
Mr Langdon was very understanding about my condition and talked me through every procedure that could help me get more mobile again. I was always at ease with him with his caring attitude. A true professional thanks. April 2019
Mr Langdon gave a full explanation of the procedure and what would happen and what to do afterwards. Perfect. May 2019
Fully informed by Consultant Surgeon and Consultant Anaethetist who put me at ease with procedure. May 2019
I saw Mr Langdon before I had the operation and he explained everything that would happen on the day of the operation. June 2019
Very attentive, understood exactly what I was saying and made me feel confident that what I was doing was the right thing. June 2019
Mr. Langdon gave you complete confidence that all would be well and that he was available if needed at any time. He showed kindness and consideration. June 2019
Calm, professional, helpful. July 2019
Everything went off so smoothly. So pleased that the operation was so successful & the next day I was able to walk around without pain. July 2019
In overall terms he was absolutely brilliant. Clearly he is a brilliant surgeon but also a wonderful and understanding human being who, whilst pointing out the risks involved in the operation, filled me with absolute confidence that if success was possible, it would definitely be achieved – and I am delighted to say that it was. He is certainly a hero to me! It was also abundantly clear that all the staff at the hospital have absolute confidence in him and hold him in the highest regard. August 2019
Excellent, he fitted me in with an early appointment and treated me extremely well. September 2019
Extremely helpful explained everything very clearly. September 2019
Mr Langdon has been very clear and concise about the treatment he would be providing and the possible outcome. He has a very professional manner and I felt very at ease with him. He provided me with lots of information and visited me numerous times after my operation to see how I was and to explain what was done and what I should expect. I would be very happy to see Mr Langdon again in the future should I have a need to. September 2019
Caring conscientious and totally professional in all respects. September 2019
Mr Langdon gave me the confidence to go ahead with surgery that I was very worried about. He is very professional and thoroughly explained all the pros, cons and side effects that could possibly happen. All of the above helped me to make a more informed decision. October 2019
James Langdon was the consummate professional. He explained his diagnosis in plain language that was easy to understand and interpret from a layman’s point of view. He was careful to manage expectations and clear about potential risks keeping them in perspective and proportionate to the circumstances. His manner was direct whilst always retaining a caring attitude listening to the patient and answering questions clearly; even taking time out to follow up with my wife whilst I was still in post Op recovery. Very thorough and I would highly recommend James. October 2019
Fully explained the treatment I required and the reasons why. I felt very confident I was in good hands. October 2019
Professional, inspires confidence. October 2019
He was very understanding explaining everything very carefully and advising me on altering medication for the procedure and when to restart normal regime. November 2019
He was courteous, listened, understood the issue very quickly. Explained everything well and was sure to confirm I understood and asked if I had questions. I didn’t feel hurried. He provided an effective and efficient service. I’d definitely recommend him. November 2019
Professional and approachable. November 2019
Extremely happy. Care was first class throughout the stay and looked after all my needs November 2019
Very approachable, caring, friendly, put me at ease. December 2019
Very approachable and knowledgeable. Felt I was in very safe hands. December 2019
Very professional throughout. December 2019
Mr Langdon diagnosed my problem, explained fully the options I had regarding treatment also all the risks involved if I chose to have an operation. Mr Langdon organised a scan to confirm his diagnosis, and explained to me prior to my operation all that was involved in the procedure. Post operation Mr Langdon visited me in my room to check on my recovery and gave me the opportunity to ask any questions on the operation. I am very satisfied with Mr Langdon and his team on my treatment. December 2019
My marks of 10 across all questions reflect my opinion of James Langdon. Brilliant in all respects, in particular his explanation to a non medical man of my problem and his solution. December 2019
Spire Harpenden Hospital
(01582) 714 304