Everything is fine. I did an MRI of the entire spine. We recorded it on disk and made a description. I did not print the photographs. It’s easy to find, there is parking (you ordered a pass for your car). Everything is on time. Although there was a recording for the opening itself. Comments, solely to improve the quality of work: 1. Recording on a disc when ordering “at a discount from the site” is paid (350 rubles, but it’s better to report this) 2. Please remind me that you need to take your passport with you))

The appointment was for an ultrasound of blood vessels (veins and arteries, as I specified when making an appointment, but in the end only an ultrasound of the veins was done and without a discount because it was Saturday, very unpleasant, deceivers - for a respecting clinic it should be a shame to fool patients (((((

EXTREMELY UNPLEASANT IMPRESSION. The appointment was denied due to a delay, which was due to the fault of the operator Olya, who could not explain how to get to the clinic from the metro. Her answer was: “Open your navigator and look.” The next day there was an appointment at another clinic with MRI images. This fact was of no interest to anyone in this “clinic”. EXTREMELY INCONVENIENT LOCATION. It's a 40-minute walk from the metro (unless, of course, you get lost in the numerous passages of Maryina Roshcha). I do not intend to use the services of this institution and do not recommend it to anyone. Positive reviews are written by doctors and administrators themselves. They often hold promotions because, apparently, there are not many clients and many have already encountered a rude and indifferent attitude. And the level of doctors, judging by the reviews, is below 3... In Moscow, for that kind of money you can find excellent service and respectful attitude towards clients. My impression is that patients are treated like cattle from whom they need to extract as much money as possible. In front of me, a man terminated the contract for medical services due to the poor quality of services. The staff seems to be random people. I’m glad that the MRI did not take place in this clinic (judging by previous reviews about the knee X-ray....). Also an equally interesting fact is X-ray exposure on the 1st floor of a residential building... A WASTE OF TIME AND NERVES. I DO NOT RECOMMEND.

MRI of the spine

The spine is the basis of the skeleton and the entire body. It holds the body in an upright position, allows us to move, and ensures communication between the brain and internal organs and limbs. The spinal column consists of vertebrae through which the spinal cord passes. There are many types of developmental abnormalities and diseases that can cause pain and complications. To understand the cause of the disorders, it is recommended to do an MRI of the spine.

Before the invention of magnetic resonance imaging, diagnosing spinal pathologies was quite a difficult task. Doctors prescribed x-rays, which made it difficult to detect abnormalities. The point is that it's flat X-ray does not allow one to see the processes taking place; only fractures or some kind of total destruction are clearly visible. And MRI of the spine is a diagnosis of more high level, allowing defects in bone tissue, intervertebral disc, nucleus pulposus and annulus fibrosus, pinched nerve roots, inflammatory processes and tumors.

All over the world, MRI of the spine is considered the most effective technique for diagnosing any disorders. It allows you to visualize all tissues in the form of a snapshot depicting a three-dimensional 3D model. Moreover, the device “photographs” from different angles and takes a series of pictures with a certain step. The result is a front, side, rear, and sectional view.

The unique technique is based on the phenomenon nuclear resonance hydrogen protons. The device does not “examine” the body with harmful radioactive X-rays, but uses a constant magnetic field and gradient magnetic disturbance. These are familiar force fields that surround us in everyday life. Therefore, the study is absolutely safe and has a minimum of absolute contraindications. It can be carried out repeatedly, for example, to monitor the patient’s condition and the dynamics of treatment.

Structurally, tomographs differ in type (closed and open) and force field strength. The last parameter is of fundamental importance if particularly accurate diagnostics are needed. For example, if testicular cancer is suspected, it is better to undergo an examination using a high-field apparatus. For a general examination, the capabilities of any tomograph are usually quite sufficient.

Why do they do it?

Spinal diseases are one of the first places in terms of prevalence. Curvatures, traumatic injuries, protrusions and intervertebral hernias, inflammatory spondylopathies, dystrophic spondylosis and osteochondrosis - office workers, athletes, and representatives of working professions suffer from these pathologies. Moreover, spinal disorders can manifest as unbearable pain in the back or in the heart, in the stomach, and kidneys. They also cause pathologies of other organs, headaches, increased arterial pressure, sexual dysfunction, urinary incontinence or, for example, paralysis of the limbs.

MRI of the spine allows you to find the cause of the disorders. Moreover, cheaper diagnostics of one department is often sufficient: cervical, thoracic, lumbar.

Indications

• back pain, headaches;
• complaints of pain in the heart and any internal organs, if there is a suspicion of irradiation;
• curvature of the spine;
• after injuries.

Does your back or head hurt, your blood pressure rises, but you don’t know the reason? Get an MRI of your spine!

Chapter 15. Radiation diagnostics of diseases and injuries of the spine and spinal cord

Chapter 15. Radiation diagnosis of diseases and injuries of the spine and spinal cord

METHODS OF RADIATION DIAGNOSTICS

The main methods of radiation diagnostics in vertebrology are MRI and CT as the most informative in the diagnosis of many diseases and injuries. However, the X-ray method is still important in the primary diagnosis of spinal pathology.

X-RAY METHOD

X-ray of the spine (spondylography)

X-rays of the spine must be performed in two mutually perpendicular projections: direct posterior and lateral. In addition, oblique radiographs are taken to show certain anatomical details, such as intervertebral joints and foramina. To determine changes in the intervertebral discs and study the motor function of the cervical and lumbar spine, a functional study is performed with spondylograms performed in the lateral projection with maximum flexion and extension of the spine.

AP X-rays of the cervical spine show the 4 lower cervical vertebrae because the upper vertebrae overlap lower jaw and occipital bone. To study the 1st and 2nd cervical vertebrae, radiography is performed in a direct projection through the open mouth. In this case, the lateral masses I are visualized on the radiograph cervical vertebra and its transverse processes, body and tooth of the II cervical vertebra. The x-ray articular space between the lateral masses of the first and articular processes of the second cervical vertebra (“lower joint of the head”) is clearly visible. With the head in the appropriate position, a gap is visible between the occipital condyles and the lateral masses of the first cervical vertebra (“upper joint of the head”). This x-ray may reveal traumatic damage to the odontoid process, destructive or degenerative changes.

An X-ray of the cervical spine in a lateral projection is intended to study this section along its entire length. On the radiograph

in the lateral projection, the vertebral bodies, intervertebral discs, joints, and spinous processes are clearly visible. Transverse processes appearing in the form of semi-oval formations are superimposed on the posterior sections of the vertebral bodies.

This x-ray makes it possible to evaluate the shape and structure of the vertebral bodies, the condition of the intervertebral discs, and identify degenerative lesions. The image is informative for fractures and fracture dislocations, inflammatory, destructive changes and anomalies of the craniovertebral region.

To identify the intervertebral foramina and posterolateral parts of the vertebral bodies, radiographs are taken in an oblique projection. The X-ray images clearly show the edges of the intervertebral foramina, the roots of the arches of the halves of the vertebrae adjacent to the X-ray film, the posterolateral surfaces of the vertebral bodies, and the intervertebral discs.

X-rays of the cervical spine under functional tests are carried out in a lateral projection under conditions of maximum flexion and extension of the neck. These images make it possible to identify the displacement of the overlying vertebrae in relation to the underlying ones, both backward and forward, and to establish the type and degree of deformation of the anterior wall of the spinal canal.

X-rays of the thoracic spine are also performed in two mutually perpendicular projections.

An X-ray image in a direct projection shows the vertebral bodies, intervertebral discs, roots of the arches, transverse and spinous processes. Costovertebral joints formed by the heads of the ribs and vertebral bodies, as well as joints formed by the tubercles of the ribs and transverse processes, are clearly visible. The spinal canal is represented by a space limited on the sides by lines drawn along the inner edges of the roots of the arches. Throughout the thoracic region, it gradually expands from top to bottom.

A lateral X-ray is designed to study the middle and lower thoracic vertebrae. The upper thoracic vertebrae up to the level of the IV vertebra are covered by a massive shadow of the shoulder girdle and are poorly distinguishable on a lateral radiograph. The radiograph clearly shows the bodies, endplates, intervertebral discs and foramina.

X-rays of the thoracic spine are used to identify various inflammatory and tumor diseases, degenerative lesions, developmental abnormalities and traumatic injuries.

The lumbosacral spine has anatomical features with x-ray examination.

A spondylogram in a direct projection makes it possible to study the shape, contours and structure of the lumbar vertebrae, the height and shape of the intervertebral discs, and the static features of the spine. The picture shows the vertebral bodies in the form of large rectangles, the size of which increases from top to bottom, the pedicles of the arches in the form of clear ovals, the arches with articular, transverse and spinous processes extending from them.

In the lateral image, the vertebral bodies and intervertebral discs are clearly visible, the end plates, as well as the roots of the arches, are clearly visible. The intervertebral foramina are also visible. Using a lateral image, it seems possible to more accurately judge the uniformity of the height of the vertebral bodies and the condition of the intervertebral discs. A lateral spondylogram provides important information for the diagnosis of developmental anomalies, degenerative-dystrophic, inflammatory, tumor diseases and traumatic lesions of this part of the spine (Fig. 15.1).

Rice. 15.1. Radiographs lumbar region spine in straight (a) and lateral

(b) projections. Norm

For a more detailed study of the condition of the intervertebral joints and sacroiliac joints, radiographs of the lumbosacral region are performed in oblique projections. These radiographs clearly show the upper and lower articular processes, the articular spaces between them, and the arch root located closer to the film is clearly visible. The radiograph visualizes the contours of the articular surfaces of the ilium and sacrum, forming the articulation.

X-ray examination of the lumbosacral spine under conditions of performing functional tests (flexion and extension) makes it possible to identify both pathological mobility and loss of mobility at the level of the affected segment.

Instability of the spinal motion segment is diagnosed when radiometry of functional spondylograms reveals a forward or backward displacement of the vertebra by more than 4 mm. Anterior or posterior displacement of the vertebra from 2 to 4 mm is a sign of pathological mobility.

X-RAY CONTRAST METHODS FOR STUDYING THE SUBARACNOUS SPACES OF THE SPINAL CORD

Currently, contrast methods for studying the subarachnoid spaces of the spinal canal have begun to be used much less frequently due to the introduction into clinical practice CT and MRI.

Pneumomyelography and positive myelography detect deformations, local compression or expansion of the subarachnoid spaces in various diseases and injuries of the spinal cord and its membranes.

X-RAY COMPUTED TOMOGRAPHY

CT allows you to obtain layer-by-layer images of various structures of the spine throughout the entire scan, namely soft fabrics paravertebral region, bone structures with trabecular and cortical layers, spinal canal containing adipose tissue, spinal cord, nerve roots, cerebrospinal fluid.

Obtaining images of the spinal cord using CT is difficult due to the low information content of the method, even after the introduction of RCS.

CT examination in spiral mode is considered the optimal diagnostic method for victims with spinal trauma. It is possible to study and characterize all anatomical changes in bone structures, adjacent organs and tissues, and assess the condition of the dural sac (Fig. 15.2).

Computed tomography myelography

In order to better visualize the structures of the spinal canal, CT myelography is performed.

With a CT myelographic study, against the background of subarachnoid spaces filled with RCS, the contours of the spinal cord are clearly visualized. You can determine its diameter and location in the spinal canal, the width of the subarachnoid spaces (Fig. 15.3).

The main advantage of this technique is the ability to determine the patency of the subarachnoid space.

MAGNETIC RESONANCE IMAGING

Regardless of the technical features of the equipment, it is mandatory to obtain T1-VI and T2-VI of the studied part of the spine in the sagittal plane. Subsequently, depending on the pathology detected on sagittal sections, images are performed in the axial or frontal plane at the level of the lesion.

Rice. 15.2.Computer tomograms of the lumbar spine: a) axial section through the body; b) axial section through the disk; c) MPR reconstruction in the frontal plane; d) SSD reconstruction in the sagittal plane. Norm

Rice. 15.3.CT myelogram of the cervical spine (MPR reconstruction). After endolumbar injection of contrast agent, the subarachnoid space (arrow) has an increased density compared to the spinal cord

MRI IMAGE OF THE SPINE AND SPINAL CORD IS NORMAL

The structures of the spine and spinal cord are best seen on T1-weighted images. In this case, the spinal cord on tomograms in the sagittal plane has an isointense signal against the background of a hypointense signal from the

barachnoid space and ligamentous apparatus. Its contours and location in the lumen of the spinal canal are clearly visualized. The bone marrow of the vertebral bodies and the nucleus pulposus of the intervertebral discs give a signal of medium intensity. The compact bone tissue of the endplates gives a pronounced hypointense signal due to the low water content. The annulus fibrosus is hypointense and merges peripherally with the endplates. The posterior longitudinal ligament is closely adjacent to the posterior surface of the vertebral bodies and is not clearly differentiated, just like the anterior longitudinal ligament. The anterior longitudinal ligament is thicker than the posterior one and is attached only to the bodies, but not to the intervertebral discs (see Fig. 15.4).

On T2-weighted images, the spinal cord, as well as the bone marrow of the vertebral bodies and the ligamentous apparatus, produce an isointense MR signal. The cerebrospinal fluid gives a pronounced hyperintense signal. The MR signal of the central part of the intervertebral discs is also high compared to the spinal cord. The outer part of the annulus fibrosus forms the peripheral hypointense part of the disc (see Fig. 15.4).

MRI scans in axial projection show that the spinal cord consists of gray matter located in the middle and white matter along the periphery. In the posterior part of the vertebral bodies, a horizontal line is visualized with a hypointense signal on T1-WI and hyperintense on T2-WI, indicating the presence of veins and venous plexuses (MR signal from a slowly flowing fluid).

Axial MR tomograms clearly visualize the contents of the dural sac and surrounding structures. The intervertebral canal is clearly visible. Against the background of a bright signal from fat located in the intervertebral foramina, the roots are clearly visualized.

Parasagittal images visualize the facet joints formed by the superior articular process of the underlying vertebra and the inferior articular process of the overlying vertebra, and the intervertebral foramina, which are filled with fat that has a hyperintense signal. Against the background of this signal, the spinal nerve exiting through the intervertebral foramen is clearly visualized.

Non-contrast MR myelography- a technique for visualizing the structures of the spinal canal without introducing CV, based on receiving a signal from the cerebrospinal fluid, when the signal from bone structures and soft tissues is suppressed.

MR myelograms clearly visualize the dural sac with its contents. The main indications for MR myelography are pathological conditions that cause compression, deformation and filling defects of the dural sac and subarachnoid spaces. Such conditions include herniated intervertebral discs, extra- and intramedullary tumors, injuries of the spine and spinal cord.

Rice. 15.4.MRI scans of the lumbar spine: T1-WI (a, c) and T2-WI (b, d) in the sagittal plane. Norm

RADIONUCLIDE METHOD

For radionuclide studies of the spine, radiopharmaceuticals based on technetium (99t Tc) are used. These include pirfotech and technefor.

Scintigraphy is performed 3 hours after intravenous administration of radiopharmaceuticals at a dose of 500 MBq.

Indications for the use of the radionuclide method are primary and metastatic tumors, systemic lesions and inflammatory diseases. Radionuclide scintigraphy is considered the best method for screening patients with suspected metastases in the spine (see Fig. 15.5 on the color insert).

To determine the stage malignant tumors They also perform radionuclide studies using radiopharmaceuticals based on positron-emitting radionuclides (PET), usually with 18 F-FDG. This study can be used both at the preoperative stage and to assess the effectiveness of surgical and chemoradiation treatment.

RADIATION SEMIOTICS OF SPINAL CORD DISEASES

Spinal cord tumors

Intramedullary tumors

CT: is not very informative, since in most cases it is difficult to differentiate the isodense tissue of the tumor and the spinal cord.

MRI: intramedullary tumors are almost always accompanied by an increase in the volume of the spinal cord and perifocal edema. An increase in the transverse size of the spinal cord in the area of ​​the space-occupying process causes a narrowing or blockade of the subarachnoid space. The tumor manifests itself as an increased MR signal on T2-WI; on T1-WI it may not be visible due to the isointensity of the MR signal of normal spinal cord tissue (Fig. 15.6).

CT and MRI contrast: accumulation of contrast agent by tumor tissue.

CT, MRI and positive myelography: thickening of the spinal cord in the area of ​​the tumor, distribution of CV in the form of thin stripes around the thickened

Rice. 15.6.MRI scan. An intramedullary formation (arrow), which has an inhomogeneous signal, causes an increase in the volume of the spinal cord, an expansion of the central canal of the spinal cord

leg spinal cord; at large sizes tumor, complete blockade of the subarachnoid space is possible. Extramedullary tumors

These tumors do not cause thickening, but rather compression of the spinal cord with expansion of the subarachnoid space above and below the tumor.

MRI: nodular formation in the dural sac, deformation of the subarachnoid space, asymmetry of the position of the spinal cord in the spinal canal and its compression (Fig. 15.7).

Rice. 15.7. Contrast-enhanced MR tomogram. Meningioma (arrow). Intensively accumulates contrast agent, is located extramedullary and pushes aside the dorsal

brain in the opposite direction

MRI contrast: tumors accumulate a contrast agent, which significantly improves visualization of the structure, boundaries and extent of the tumor.

CT: nodular dense (35-45 HU) formation in the dural sac, calcifications in the tumor, changes in the bone structure of the walls of the spinal canal in the form of sclerosis, hyperostosis, destruction, atrophy.

CT contrast reveals increased

Rice. 15.8. CT myelogram. Meningioma (arrow). Located on the left extra-dural, pushes the dural sac to the opposite side

decrease in density in the tumor.

CT and MRI myelography allows us to clarify compression of the spinal cord with a corresponding expansion of the subarachnoid space above and below the tumor. On CT myelograms, these tumors are visualized as an area of ​​defect in the filling of the dural sac; deformation and displacement of the spinal cord by a space-occupying formation are also revealed

(Fig. 15.8).

Positive myelography: defect in the filling of the subarachnoid space of the spinal cord with displacement and compression of the spinal cord.

Spondylography: symptoms of pressure atrophy - increase in the frontal diameter of the vertebral

canal as a result of atrophy of the roots of the arches (Elsberg-Dyck symptom); shortening of the arch root; expansion of the intervertebral foramen, deepening (excavation) of the dorsal surfaces of the vertebral bodies.

Demyelinating diseases

Of all the demyelinating diseases, multiple sclerosis is the most common. In the acute stage of the disease, all elements of inflammation and degeneration are determined.

The priority method of radiological diagnosis is MRI, although foci of demyelination are also detected by CT, but much worse. Demyelination processes are accompanied by a decrease in X-ray density due to excessive hydration of pathologically altered tissues.

CT: Type I - focal decrease in density (0...+15 HU) without accumulation of RCS; Type II - accumulation of contrast agent in isodense foci, but the enhancement is most often delayed, and therefore CT should be performed no earlier than 10-25 minutes after intravenous administration of RCS.

MRI: a pathognomonic sign is the detection of intramedullary plaques, often in the cervical spinal cord, less often in the thoracic. Plaques multiple sclerosis are better detected on T2-weighted images, on which they have the appearance of a hyperintense focus against the background of an unchanged spinal cord. In the active stage, in addition to plaques, local swelling of the spinal cord is determined.

MRI contrast allows you to establish the activity of the process for the accumulation of EF.

Inflammatory diseases

Intramedullary inflammatory diseases include primarily transverse myelitis- inflammatory process of the spinal cord, having a polyetiological origin ( viral infection, acute disseminated encephalomyelitis, spinal cord sarcoidosis).

MRI: fusiform expansion of the spinal cord with a decrease in the intensity of the MR signal on T1-weighted images and an increase on T2-weighted images.

MRI contrast: increased intensity of the MR signal on post-contrast T1-weighted images, characteristic of an inflammatory process.

Intradural extramedullary inflammatory diseases include: arachnoiditis, acute and subacute leptomeningeal infections.

Arachnoiditis

In the classic version, it manifests itself as adhesions of the spinal cord membranes involving the roots of the spinal nerves and brain tissue.

MRI: compression, deformation of the roots inside the subarachnoid space, thickening of the membranes of the spinal cord, narrowing and heterogeneity of the structure of the subarachnoid space.

Extradural inflammatory diseases include specific and nonspecific spondylitis (osteomyelitis).

Osteomyelitis

X-ray: at the onset of the disease, destruction of the spongy substance of the vertebral body and blurred contours of the endplate are determined. At

As the process progresses, destruction and deformation of the vertebra, and the formation of sequesters are revealed (see Fig. 15.9).

Rice. 15.9.X-ray. Osteomyelitis C 5 vertebra. Endplate destruction with vertebral deformity

CT: areas of destruction of the spongy substance of the vertebra; unevenness (usuration) of the contour of the end plates; formation of sequesters; damage to paravertebral structures around the affected vertebra or at a significant distance from the primary lesion; damage to the posterior parts of the vertebra (dorsal part of the body, arches, articular processes). CT can detect minimal changes in early stages process (Fig. 15.10).

MRI: at the beginning of inflammation, an increase in the MR signal on T2-weighted images from the bone marrow due to its edema (see.

rice. 15.11).

Paravertebral soft tissue inflammatory changes are clearly detected in the form of foci with an increased MR signal on T2-weighted images against the background of a low signal from the muscles.

Acute epidural abscess- a rare pathology with hematogenous dissemination. In chronic epidural abscess (epiduritis), inflammation occurs directly from the vertebra into the epidural space.

Rice. 15.10.Computer tomograms. Osteomyelitis of Th7-8 vertebrae. Destruction of vertebral bodies with the presence of a paravertebral soft tissue component (arrows)

Rice. 15.11. MRI scan. Spondylitis of L2, L3 vertebrae. On the non-contrast MR myelogram (c) there is a block of cerebrospinal fluid dynamics. On T2-weighted image in the frontal plane (d) a paravertebral inflammatory soft tissue component is visualized (arrow)

MRI: the abscess has a convex shape, usually with a hyperintense MR signal on T2-weighted images (see Fig. 15.12). Specific (tuberculous) spondylitis

Damage to the vertebral bodies, intervertebral discs, formation of a cold abscess and paravertebral leak. Typically, multiple vertebrae are affected.

Rice. 15.12.MRI scans. Epidurit. Thin strip of hard meninges(arrow), having a hypointense MR signal against the background of a hyperintense MR signal from fluid (pus) and an isointense MR signal from the spinal cord

X-ray: destruction of the vertebral bodies with spread to the intervertebral disc; wedge-shaped deformity of the vertebral bodies.

CT, MRI: destruction of bone tissue in adjacent vertebrae; wedge-shaped deformity of the vertebral bodies; involvement of paravertebral structures in the pathological process with the formation of an infiltrate with a layered structure and inclusions of bone density; complete destruction of the intervertebral disc. The posterior structures of the vertebral bodies are not affected.

Vascular diseases

Arteriovenous malformation of the spinal cord

MRI: intramedullary AVMs are manifested by tortuous dilated vessels supplying blood to the pathological node. On T1-WI and T2-WI, the effect of loss of MR signal is noted. The AVM node is more clearly visualized on T2-WI against the background of a hyperintense MR signal from the cerebrospinal fluid (see Fig. 15.13).

Spinal angiography: a conglomerate of pathologically altered vessels with dilated arteries and veins.

Vertebral hemangiomas- these are extradural AVMs, benign lesion vertebral bodies. Several vertebrae are often involved in the pathological process.

CT: on axial sections the picture resembles “polka dot tissue”; in the capillary form, thinning or breakthrough of the cortical layer (“bloating”) is noted (see Fig. 15.14).

Rice. 15.13. MRI scans. The AVM node (black arrow) is represented as a section heterogeneous change MR signal intensity, dilated vessels are visualized in the form of linear sections of hypointense MR signal (white arrow)

Rice. 15.14. Computer tomograms. Hemangioma of the L2 vertebral body (arrows)

MRI: on T1-VI there is a zone with a decrease in the intensity of the MR signal. On T2-weighted images the signal is enhanced (Fig. 15.15).

Spinal cord infarction

MRI: change in the intensity of the MR signal characteristic of ischemia and cerebral edema. In the acute stage, a decrease in the intensity of the MR signal is noted on T1-WI, and a moderate increase on T2-WI. The localization of the altered signal corresponds to the area of ​​​​the blood supply to the affected

arteries: with the anterior spinal artery - along the anterior edge, with the posterior - along the posterior surface of the spinal cord.

Rice. 15.15. MRI. Hemangioma of the L2 vertebral body

Intramedullary cysts

Syringomyelia

This congenital disease, which is a combination of developmental anomalies of several organs and systems and is accompanied by pathological growth and cystic degeneration of glial tissue of the spinal cord.

Radiation diagnostics of syringomyelia is based on identifying a syringomyelic cyst and accompanying bone lesions.

CT: The syringomyelic cyst has a reduced density.

MRI: A syringomyelic cyst on T1-weighted imaging gives a hypointense signal, while the signal on T2-weighted imaging can vary from hyper- to isointense. Cysts are usually confluent and have incomplete septa (see Fig. 15.16). The image of the cavities resembles the “gaustra” of the colon on x-ray examination. Many authors compare these images to a “stack of coins.”

MRI contrast: When using paramagnetic HF, there is no accumulation.

Degenerative-dystrophic diseases

Degenerative-dystrophic diseases of the spine are represented by osteochondrosis, spondylosis deformans and spondyloarthrosis deformans.

Osteochondrosis

Spondylography: violation of statics in the form of flattening of the lumbar lordosis, scoliosis; change in the height of intervertebral discs with sclerosis

end plates; anterior, posterior or posterolateral marginal bone growths - osteophytes; restriction of physiological mobility or displacement of one vertebra in relation to another (pathological mobility, spondylolisthesis); calcification of the prolapsed part of the disc.

Rice. 15.16.MRI scans. Syringomyelic cyst. T2 WI (a), T1 WI (b), T2 WI three-dimensional ciss sequence (c), multiplanar reconstruction in the frontal plane (d)

CT: decrease in the height of the intervertebral disc with the appearance of a “vacuum phenomenon”: pockets of air density (-800...-900 HU) with clear contours; compaction of the end plates; sclerosis of the subchondral layer; Schmorl's hernia and/or Pommer's hernia (formed as a result of the penetration of the damaged nucleus pulposus of the intervertebral disc into the spongy substance of the vertebral body with destruction of the endplate).

Schmorl's hernia on CT is visualized as a lesion in the spongy substance of the vertebral body, adjacent to the endplate, with a density of +50...+60 HU, surrounded by a rim of increased density to +250...+300 HU (see Fig. 15.17).

Rice. 15.17.Computer tomograms. Schmorl's hernia. Violation of the integrity of the endplate of the vertebral body (arrows)

MRI: a decrease in the intensity of the MR signal from the intervertebral discs, more pronounced on T2 images, along with all of the above signs (Fig. 15.18).

Herniated discs

The most significant is the posterior or posterolateral displacement of the intervertebral disc, as it causes clinical and neurological symptoms.

Spondylography allows you to identify signs of disc chondrosis, assess the condition of bone structures, and detect osteophytes.

Myelography: filling defect along the anterior or anterolateral contour of the gas column or RCS. With large disc nodes, the RCL column becomes disconnected at the level of the prolapsed disc or stops at the upper edge of the cartilaginous node.

CT: high-density formation (70-110 HU), extending beyond the endplates; reduction (absence) of differentiation of epidural fat; displacement of the nerve root and compression of the dural sac

(See Fig. 15.19).

CT myelography expands the diagnostic capabilities of native CT.

MRI: the herniation gives a signal of the same intensity as the damaged disc (Fig. 15.20). A hyperintense signal is produced by the sequester.

MRI contrast: contrast enhancement is observed in the postoperative scar tissue, and the disc tissue becomes more visible.

MR myelography: filling defect or breakage of contrast at the level of the damaged intervertebral disc.

Spondyloarthrosis deformans

The spine has joints between the vertebral bodies and their processes. As in any joint, degenerative lesions can develop in them.

X-ray, CT, MRI: narrowing of the joint space, thickening of the endplate of bone, subchondral sclerosis of bone tissue, marginal bone growths, cystic clearing at the articular ends of the bones.

Rice. 15.19. Computer tomograms. Left-sided intervertebral disc herniation

L3-L4 (arrows)

Rice. 15.18. MRI scans. Schmorl's hernia. Violation of the integrity of the caudal endplate of the Th10 vertebral body (arrow) with disc prolapse into the vertebral body

Spondylosis deformans

Dystrophic changes occur in the peripheral layers of the fibrous ring and in the anterior longitudinal ligament of the spine, the height of the intervertebral discs is maintained. No foci are identified in the vertebral bodies, but bone growths are detected, which seem to extend from the anterior surface of the vertebral bodies or from its lateral surfaces and are a consequence of ossification of the anterior longitudinal ligament, which surrounds the vertebral bodies on three sides. Ossification of the anterior longitudinal ligament over many vertebrae, in contrast to deforming spondylosis (affecting 2-3 adjacent vertebrae), is classified as special disease- fixing ligamentosis (Forestier disease).

X-ray, CT, MRI: anterior marginal bone growths that extend over intervertebral disc, ossification of the anterior longitudinal ligament.

Rice. 15.20. MRI scan. Posterior disc herniations L4-L5, L5-S1 (arrows)

RADIATION SEMIOTICS OF SPINE AND SPINAL CORD INJURIES

Injuries to the cervical spine

Damage to the 1st and 2nd cervical vertebrae

Spondylography: a sign of atlas dislocation is considered to be a widening of the gap of the median atlanto-axial joint (Cruvelier's joint) by more than 5 mm, subluxation - up to 3-4 mm (normally, the width of the joint space is 2-2.5 mm).

With transdental dislocations of the atlas, fractures of the tooth of the II cervical vertebra occur. X-rays taken through an open mouth reveal various options displacement of a tooth fragment.

CT: All types of vertebral fractures and dislocations are clearly visualized on sections in the axial plane. CT has high diagnostic capabilities in determining the directions of displacement of bone fragments (see Fig. 15.21).

Damage at the level of III-VII cervical vertebrae

Ligament ruptures, damage to intervertebral discs, vertebral dislocations and subluxations, compression fractures, etc. may occur.

Spondylography: On radiographs in the lateral projection, anterior displacement of the dislocated overlying vertebra is determined, resulting in the formation of angular kyphosis or a step-like deformity. A compression fracture is manifested by a wedge-shaped deformation of the vertebral body and compaction of its bone structure.

CT allows you to characterize in detail the type of damage, displacement of bone fragments and deformation of the spinal canal.

MRI: The advantage of the method is to identify disturbances in cerebrospinal fluid dynamics and damage to the spinal cord (bruise, hemorrhage) (see Fig. 15.22).

Rice. 15.21.Computer tomogram. Fractures of the anterior and posterior arches of the first cervical vertebra (Jefferson fracture)

Rice. 15.22.MRI scans. Compression fracture of the C6 vertebral body (arrow). Decreased height of the C6 vertebral body; a block of liquor dynamics is determined at this level

Injuries to the thoracic and lumbar spine

Compression fractures

Spondylography: decreased height, wedge-shaped deformation of the vertebral body and uneven compaction of the vertebral body structure; rupture of the supra- and interspinous ligaments is diagnosed by an increase in the distance between the apices of adjacent spinous processes or a displacement of the apex of one of them away from the midline by 2 mm or more (Fig. 15.23).

CT: Direct and indirect signs of fractures are clearly identified. Signs of ligament damage are fan-shaped separation of adjacent spinous processes and disruption of the structure of damaged ligaments (Fig. 15.24).

Myelography: reveal partial or complete blockade of the subarachnoid spaces and, consequently, the presence, origin and direction of compression of the contents of the dural sac.

CT myelography: it is possible to more subtly differentiate the type of compression of the contents of the dural sac (bone or soft tissue). With partial blockade of the subarachnoid spaces, a defect or narrowing of the shadow of the contrasted dural sac, as well as its deformation, is observed. When it is completely blocked, the phenomenon of “stop contrast” is observed, i.e. the contrast agent does not spread above the level of compression of the contents of the dural sac.

Rice. 15.23. X-ray. Compression fracture of the Th10 vertebra

MRI: decrease in height and wedge-shaped deformation of the vertebral body, kyphotic deformity, change in the intensity of the MR signal of the damaged vertebral body (see Fig. 15.25).

Rice. 15.24. Computer tomograms. Compression comminuted fracture

L1 vertebral body (arrows)

Rice. 15.25. MRI scans. Compression fracture of the Th10 body with rupture of the spinal cord. Increased intensity of the MR signal from the spinal cord above and below the rupture site - bruises (arrows), a block of liquor dynamics is determined at this level

MR myelography reveals compression of the dural sac. Spinal cord injuries

The most informative radiological diagnostic method for detecting spinal cord injuries is MRI.

MRI determines compression of the spinal cord and cauda equina roots not only by bone structures, but also by areas of damaged discs, ligaments, as well as epidural hematoma.

Hemorrhages in the acute stage are determined as an area (focus) of changes in the intensity of the MR signal of the spinal cord. On T1-WI the hemorrhage gives an isointense signal, on T2-WI it gives a hyperintense signal. In the subacute stage, both on T1-WI and on T2-WI, hemorrhage gives a hyperintense MR signal.

MRI allows visualization of spinal cord rupture in severe spinal injury.

CT: A hematoma in the acute stage manifests itself as an area of ​​increased density.

June 17, 2019

Treatment of diseases of the musculoskeletal system and any related disorders and pathologies is impossible without determining the correct diagnosis and developing the correct tactics of treatment, which should include all available medical complex funds.

There is a main difficulty in diagnosis - the similarity of symptoms and manifestations of various spinal diseases, the treatment of which may differ from each other to a significant extent. Complex diagnostics goes through several main stages, to which, as necessary, are added other highly specialized studies aimed at clarifying information about the patient’s health status:

• Anamnesis collection.
• Physical examination.
• Instrumental methods.

After receiving data from a physical examination and instrumental methods, the attending physician will diagnose accurate diagnosis and will develop an initial treatment strategy, which will be adjusted as its effectiveness is determined.

History taking

The initial doctor’s appointment begins with a detailed questioning of the patient about the symptoms of the disease, the duration and severity of manifestations, associated problems that arise, previous injuries or illnesses, hereditary predisposition to certain diseases, lifestyle, type of work, etc.

All this information will be entered into the patient’s card, regardless of what problems brought him to the clinic - back treatment for radiculitis, headaches, osteochondrosis, osteoporosis, vertebral fractures, etc. The most typical questions asked to patients:

• How long ago did the pain start?
• Where exactly are they located?
• What is the nature and severity of pain?
• What factors increase or decrease pain symptoms?
• Are there any problems with urination or bowel movements?
• Is there loss of sensation in the limbs, etc.

Physical examination

After an oral interview and clarification of specific complaints, the doctor begins a physical examination of the patient, which is necessary to make a preliminary diagnosis and draw up a plan for further laboratory and instrumental examination methods.

It includes the following tests:

• A visual examination of the spine, which is carried out as follows - the patient stands with his back to the light source, stands straight, barefoot, arms hang freely along the body, muscles are as relaxed as possible. The second examination position is bending forward with relaxed arms lowered to the floor. As a result, based on the identification points of the spine, the doctor can diagnose: spine normal structure, flat back, hunched back, round back, kyphosis, scoliosis
• Palpation of the back and neck, special attention is paid to the localization of pain.
• Study of tendon reflexes.
• Determination of active mobility of the spine.
• Determination of sensitivity skin in different areas, the presence of color changes, abrasions, wounds, swelling, new anatomically irregular folds.
• Determination of the muscle strength of the limbs, their pathological settings, changes in the correct axis due to curvature in the joints or within a specific segment.
• Determination of manifestations of nerve root tension, which is necessary for diagnosing a vertebral hernia, treating nerve root entrapment in spinal cord stenosis, etc.
• Examination of joints for changes in shape, contours, and the presence of excess fluid in them, which can be caused by synovitis or hemarthrosis.
• Establishment of compensatory changes that form in the overlying sections due to pathologies of the lower ones. For example, prolapse of half the pelvis on one side and compensatory scoliotic changes in the spine on the healthy half of the body are caused by a decrease in the angle between the femoral neck and the diaphysis of the femur.

To avoid mistakes when making a diagnosis, the doctor does not limit himself to examining only the affected part of the spine or the location of pain. During the examination, attention is paid to the peculiarities of the patient’s gait, forced posture, and the position of the limbs at rest and in motion. That is, all bone structures are examined, regardless of the location of the pain, since they are all closely related to each other.

Instrumental examination methods

After a physical examination, a preliminary diagnosis is made, which requires clarification using instrumental research methods. Most often, when treating spinal diseases, a vertebrologist prescribes the following types of diagnostics:

• Radiography.
• Ultrasound of the spine.
• Magnetic resonance imaging (MRI).
• Computed tomography (CT).
• Myelogram.
• Radioisotope scanning.
• Electromyography.
• Diagnostic blockade of facet joints.
• Lumbar puncture.
• Discography.
• Venospondylography.
• Densitometry.

Most modern doctors strive to resort to research methods such as myelogram, radioisotope scanning, disc and venospondylography as little as possible, since they relate to invasive techniques, in addition, their disadvantages include possible individual intolerance and allergic reactions to injected radiopaque agents.

Radiography

The study of the bone structures of the human body, which is performed by exposing them to x-rays and then displaying the results on a special film or paper.

Most often, radiography is performed in the diagnosis and treatment of osteochondrosis, various fractures, and spinal tumors. The images clearly show various degenerative changes in the spine: osteophytes (bone growths on the edges of the vertebral bodies), changes in the height of the vertebrae themselves and the distance between them, hypertrophy of the facet joints, the presence of some infectious lesions, for example, spondylitis.

Functional radiography is one of the subtypes of the main study, which is designed to determine the instability of the motion segments of the spine. The pictures are taken with the back at maximum flexion and extension.

The advantages of this type of research are wide range diagnosable problems, complete painlessness and high speed obtaining results.

Disadvantages include high radiation exposure, which limits the number of examinations over a period of time and categories of patients, for example, pregnant women, adolescents and children undergo radiography in the most extreme cases. Also, the x-ray does not visualize the soft tissues that support the musculoskeletal system - muscles, ligaments, intervertebral discs, etc.

Ultrasound of the spine

The safest and most inexpensive method of instrumental examination of a patient’s condition today, ultrasound is indicated for all categories of patients, even pregnant women and children. Based on the results of ultrasound, pathologies of soft and cartilaginous tissues are determined, and the bone tissues of the spinal column and the structures of the spinal canal are partially visualized with higher detail than radiography.

This research method is used for scoliosis, in the treatment of osteochondrosis, herniated intervertebral discs, osteochondrosis, rheumatism and many other diseases and pathological conditions spine.

Magnetic resonance imaging (MRI)

MRI is a modern, high-precision method of obtaining images of tissues and organs using electromagnetic waves. The digital data obtained during tomography are transferred to a computer and, after processing, are presented in the form of a series of sections in longitudinal and transverse projection.

Currently, MRI is considered the “gold standard” for diagnosis. pathological changes nerve structures, muscles, ligaments and other soft tissues. The images clearly show degenerative changes in the intervertebral discs, spinal canal stenosis, intervertebral hernias, hypertrophy of the facet joints and similar pathologies.

The advantages of this method are:

• complete painlessness;
• quick receipt of research results;
• complete safety for the patient due to the absence of radiation exposure, which allows its use for all patients without restrictions, as well as repeated MRI for one patient to monitor the treatment process, for example, for osteoporosis, treatment of this disease takes a long time and requires constant monitoring by a doctor .

Computed tomography (CT)

CT is a method of studying human tissues and organs using x-rays. The information received is processed on a computer, and just like with MRI, it undergoes computer processing to obtain images of organs and tissues in longitudinal and transverse sections.

Computed tomography makes it possible to examine both bone structures and soft tissues, combining the capabilities of X-ray and MRI. The study is effective for identifying pathological processes in bone tissue, for example, hypertrophy of facet joints, proliferation of osteophytes.

Among the disadvantages of CT, one can note the radiation load on the patient’s body, as well as the reduced accuracy and clarity of the tomographic image compared to MRI images. Often, to increase the information content of the examination when diagnosing the condition of soft tissues and their pathologies, CT is combined with a myelogram.

Myelogram

This X-ray examination has been used for many years to diagnose pathologies of the spinal cord and spinal canal. Its peculiarity is the introduction of a radiopaque substance under the membranes of the spinal cord through lumbar puncture in the lumbar region. The substance spreads along the spinal canal, flows around the spinal cord and nerve roots.

The examination is carried out on the operating table, which periodically changes its position. The contrast agent spreads in different directions, facilitating visualization of spinal structures at different levels.

Myelography reveals a spinal tumor, a herniated disc, a spinal fracture, and diagnoses compression of the dural sac, which contains the spinal cord and cerebrospinal fluid, nerve roots, and changes in the circulation of the cerebrospinal fluid.

Radioisotope scanning

Radioisotope diagnostics is carried out by recording the radioactive radiation of the body after the introduction of a radioactive drug into it. The examination is performed in a special gamma camera.

The isotope is redistributed throughout the body and accumulates differently in certain tissues and organs. In normal healthy tissues isotopes accumulate evenly, and in pathological areas there is insufficient or excessive accumulation, forming a cold or hot focus, respectively.

To diagnose various pathologies, for example, changes in the thyroid gland, lungs, and bone tissue, different isotopes are used. In diseases of the spine, radioisotope diagnostics is used to determine pathological changes in the vertebrae, detect tumor diseases of the spine, and metabolic disorders in the bones, for example, osteoporosis.

Radioisotope scanning does not pose a danger to the human body, since the half-life of medical isotopes is only a few hours at extremely low radiation intensity.

Electromyography

Electromyography is the study of the function of peripheral nerves, neuromuscular junctions and muscles using electrical impulses. An electrode is placed on the surface of the skin or deep within the patient’s muscle being examined, through which waves propagate. The computer records spontaneous muscle potentials, as well as their electrical activity during special electrophysiological tests.

Based on electromyography data, a conclusion is made about the conductive ability of the fibers, and various diseases of muscles and nerve tissue are diagnosed.

Electromyographic examination is safe and virtually painless for the patient, but may cause some discomfort during muscle contractions.

Diagnostic blockade of facet joints

Facet joints are special structures of the spine that, on the one hand, stabilize the vertebrae, and on the other, allow them to maintain flexibility for turning the torso and head during walking, turning and bending.

Facet joints are present in all parts of the spine, and like any other joints human body are susceptible to inflammation, damage and can become sources of pain. To exclude the presence of pathology of these joints, a diagnostic blockade with an anesthetic is performed.

If, after introducing the solution into the cavity of the facet joint and subsequent blockade of the nerve fibers, the pain syndrome goes away, then the source of the patient’s problems is precisely this part of the spine. A failed block indicates that the patient has another spinal disease with similar symptoms.

Lumbar puncture

Liquor is a clear cerebrospinal fluid that contains proteins, glucose and other substances in a certain concentration, and normally should not contain leukocytes or red blood cells. Collection of cerebrospinal fluid for research and measurement intracranial pressure called a lumbar puncture.

Laboratory examination of lumbar puncture allows us to determine the presence of a brain tumor, subarachnoid hemorrhages, and various infectious lesions nervous system, for example, meningitis, tuberculosis, syphilis, etc.

A puncture is performed below the second lumbar vertebra to exclude damage to the spinal cord. A special thin needle is inserted between the spinous processes of the vertebrae until the membrane of the spinal cord is punctured. During the puncture, the pressure of the cerebrospinal fluid in the membrane is simultaneously measured and several ml of liquid are taken for subsequent laboratory analysis.

Discography

This is a fluoroscopic examination with the additional injection of a contrast agent exactly into the center of the intervertebral disc. Most often, the need for discography arises before surgery to accurately determine disc pathologies.

As a result, a variety of intervertebral disc disorders are diagnosed - hernias and protrusions, ruptures of the fibrous ring, changes in the shape or height of the disc. During the administration of a contrast agent, the patient experiences severe pain in the affected disc; experts consider this to be a separate issue. diagnostic test and is called a provocative discography.

This test is useful in determining the condition of the intervertebral discs, for example, if there are no noticeable signs of damage. But most specialists are increasingly resorting to this technique, since it is technically quite complex, and there are many other available non-invasive and gentler ways to visualize the condition of the discs.

Venospondylography

VSG is an X-ray examination of the venous plexuses of the spine with contrasting of the venous tracts due to the introduction of a radiopaque substance into the spongy tissue of the spinous processes of the vertebrae.

This method is used to assess the condition of the venous plexuses and early diagnosis space-occupying formations in the epidural space.

Densitometry

This is a modern, highly accurate method for early diagnosis and monitoring of the progress of treatment of osteoporosis, which analyzes bone density and bone loss in comparison with the average indicators for the group. Results different from the norm are a serious reason to seek advice from an osteopath.

The objective advantages of this method include its complete painlessness, safety for the patient, affordable price, densitometry is effectively used not only for diagnosing osteoporosis, but also for intermediate examinations during long-term treatment of the patient for this disease.

Dr. Bobyr's clinic invites everyone to receive an in-depth consultation with our experienced specialists - vertebrologists, osteopaths, traumatologists, surgeons, chiropractors, conduct full diagnostics your musculoskeletal system and receive effective qualified medical care. Our spine treatment center in Moscow is fully equipped with all the necessary examination equipment.

The spine is the main part of the human axial skeleton, which, in addition to the spinal tube, also consists of the bones of the skull, sternum and 12 pairs of ribs. The spine is the main element of the musculoskeletal system and performs the most important functions: protects the spinal cord from external factors and increased load, provides the ability to move the head and neck, helps maintain balance while walking (due to ventral and dorsal bends) and correctly distribute body weight person. The condition of the spine determines not only a person’s ability to move, but also the health of the digestive, nervous and respiratory systems, as well as the blood supply to the brain and pelvic organs.

In most cases, a spinal examination is performed if there is pathological symptoms(mainly pain and paresthesia), but comprehensive diagnostics may also be indicated for preventive purposes to identify risk factors for the development of vertebrogenic pathologies. The choice of an appropriate diagnostic method is made by the attending physician, since all types of examination have their own goals, features and degree of information content.

The frequency of detection of pathologies of the musculoskeletal system in adults and children in almost all developed countries is rapidly increasing every year. Such data is provided not only local authorities health care, but also the WHO, whose experts believe that every third resident of large cities has back problems. Experts call the main reason for the massive spread of osteochondrosis, scoliosis and other diseases of the spine, which are detected even in childhood, a progressive decrease in motor load. It is noteworthy that against the background of persistent hypodynamic disorders (pathologies that develop against the background of a sedentary lifestyle), in some cases increased physical activity that does not correspond to the degree of fitness and age of a person can provoke spinal diseases.

Specialists in the field of vertebrology and related sciences are seriously concerned about the current trend, since various disorders in the structure and functioning of the spine and its elements (intervertebral discs) affect the general well-being of a person and the functioning of the most important organs, including the bronchopulmonary system and the heart muscle. The most important arteries (basilar and carotid) pass through the cervical and thoracic spine, along which oxygenated and nutrients blood flows to all parts of the brain. Various pathologies of these segments of the spinal tube (intervertebral hernias and protrusions, bone growths, displacement of the vertebrae, etc.) can cause compression of these arteries, provoking the development of oxygen deficiency and related complications.

Important! A person with spinal problems may complain of migraines, headache, pressure changes, heart pain, numbness of the limbs, tinnitus. Primary diagnostics do not always make it possible to make a correct diagnosis and determine the cause of such conditions, so neurosurgeons propose to include a spinal examination in the complex of mandatory diagnostic measures for chronic or poorly controlled headaches, arterial instability, sensory disturbances in the upper and lower extremities.

Indications for diagnostics

The main complaint for which a patient may be prescribed a spinal examination is pain in various parts of the back. Diagnosis of spinal pain syndrome of any intensity is aimed not only at identifying diseases and defects of the spinal tube, but also excluding pathologies with similar symptoms. For example, pain in the area chest against the background of intercostal neuralgia (a common complication of osteochondrosis) must be differentiated from restrictive and arrhythmogenic cardiomyopathy, angina pectoris and other heart pathologies. Painful sensations in the lower back can be manifestations of a number of diseases, including those not associated with vertebrogenic disorders: diseases genitourinary system, adhesions in the pelvic area, some systemic infections ( extrapulmonary forms tuberculosis, syphilis, etc.).

In addition to spinal pain, indications for prescribing a comprehensive examination of the spine (not excluding other diagnostic methods) are the symptoms listed in the table below.

Indications for diagnosing the spine

Which part of the spine needs to be examined?	Image	Indications ( clinical symptoms) for diagnostics
		Chronic headaches, especially if they are accompanied by dizziness, congestion ears(tinnitus), changes blood pressure. Stiffness in the neck and shoulder girdle(upper back), increased tonic tension in the neck muscles, blurred vision. Decreased performance, sleep disturbance, constant weakness are also grounds for examination of the cervical spine, as they are typical signs disturbances of blood flow in the most important arteries that supply blood to the brain (carotid and basilar)
		An examination of the thoracic spine may be required if there is frequent pain in the chest area (with possible spread to the shoulder, scapula, upper limbs), respiratory failure(shortness of breath, pain when inhaling), burning and tingling in this part of the back
		Diagnosis of the lower parts of the spinal tube, which in addition to the lower back also includes the sacrum and coccyx, may be required not only for pain in this localization, but also for many other symptoms: defecation and urination disorders, chronic pelvic pain, paresthesia and paralysis in the lower extremities

Note! In men, indications for examination of the lower spine may include erectile dysfunction, decreased libido, chronic disorders in the functioning of the organs of the genitourinary system (seminal vesicles, prostatic glands, etc.). These organs are innervated (controlled) by the lower parts of the spinal cord, located in the central spinal canal, so diagnostics of the spine is necessary if the neurogenic nature of the existing disorders is suspected.

Types and methods of vertebral diagnostics

Today, there are several methods for diagnosing spinal diseases, but the attending physician must decide which examination to prescribe for the patient. Each of the methods used has its own disadvantages and advantages, but when prescribing diagnostic measures, the specialist first of all takes into account possible contraindications and the degree of information content of the chosen method.

Nuclear magnetic resonance imaging (MRI)

This is a medical imaging technique anatomical structures and human tissues for the purpose of research using the effect of nuclear magnetic resonance (for this reason, until the 80s of the twentieth century, the method had a different name - NMR therapy). Despite the fact that the magnetic resonance scanning method was first proposed only a few decades ago (in 1973), today MRI is considered the most reliable and informative method for diagnosing spinal diseases. Its undoubted advantage is the ability to study human soft tissues, which is not available when using other methods, therefore magnetic resonance imaging is the basis for diagnosis in cases of suspected osteochondrosis and its complications (hernias, protrusions).

In addition to classical nuclear magnetic resonance scanning, there are other types of MR, for example:

The most reliable type of nuclear magnetic resonance scanning for identifying spinal pathologies is MRI with an axial (vertical) load. This is a modern method of examining the sacral and lumbar spine, the most effective for identifying intervertebral hernias and vertebral instability. The study is carried out in two stages: first, the spine is examined in calm state without load (in a supine position), after which the table together with the tomograph rises to vertical position. The entire procedure can take from 20 to 45 minutes.

Preparation

Any special preparation, as well as premedication, is usually not required before the MRI procedure, but the study itself requires compliance with certain rules. Before the scanning session begins, it is necessary to remove all metal jewelry (including removing piercings from the tongue, genitals, umbilical ring, etc.), belts, bracelets, watches. If the patient uses transdermal systems for treatment (patches), they must also be removed 20-30 minutes before the procedure. If you have tattoos made with synthetic coloring pigments, you must inform your doctor, as this may be a contraindication for examination (with the exception of tattoos made with henna).

Before the procedure, during a conversation with the attending physician, you need to find out how long the procedure will last, where the signal button is located (in case of paroxysmal attacks of episodic anxiety associated with being in a confined space), and what significance this type of examination has specifically for his disease.

The average duration of MRI diagnostics is about 25 minutes.

For whom is MRI scanning contraindicated?

Contraindications (some of them may be relative) for MRI of the spine include:

• the presence of any built-in and removable structures and implants (braces, dentures, pacemakers, compression-distraction devices, insulin pumps, hemostatic clips, implants inner ear etc.);
• claustrophobia;
• the patient is under the influence of drugs or alcohol;
• hemolytic type anemia.

Note! Despite the limited data on the possible teratogenic effects of MR radiation on the fetus, this method The study is considered safer compared to other diagnostic procedures. If it is necessary to use contrast, MRI diagnostics are prohibited at any stage of pregnancy.

Spiral computed tomography

Spiral or multispiral (multilayer) computed tomography is a method of layer-by-layer scanning of the spine and other anatomical structures of the body using radiation exposure. During CT and MSCT, the body is exposed to increased doses of radiation, so it should be used only in case of urgent need if there is emergency indications, for example, for quickly diagnosing injuries, fractures or displacements.

Some people think that computed tomography does not detect soft tissue pathologies, but this is not true. In the images, tumors (including small neoplasms) and blood vessels are clearly visualized, but, unlike magnetic resonance imaging, a multispiral scanner does not cover organs hidden behind the large bones of the skeleton. Such organs and structures include the spinal cord and brain, intervertebral discs, and pelvic joints.

The method due to the high degree radiation exposure has more contraindications compared to MRI and X-ray examination. These include:

• high body weight (depending on the size of the device, the maximum permissible weight of a person can be from 130 to 150 kg);
• pathologies of the thyroid gland and renal system (kidney diseases can cause retention of the contrast agent in the body and increase the toxic load on internal organs and fabrics);
• severe forms of diabetes mellitus;
• generalized plasmacytoma.

CT examination is contraindicated at any stage of pregnancy. This diagnostic method does not require special preparation.

X-ray examination

This is the most common method for diagnosing the spine, which is widely used in municipal medical institutions and is almost always the main method at the initial examination stage. X-rays can reveal damage and trauma to the spine, vertebral displacement, and the presence of bone growths(osteophytes), signs of inflammatory and tumor processes. If the doctor suspects damage to several segments of the spine, images of each of them are taken separately in several projections: direct, lateral and two oblique. In some cases, functional radiography is also used, when photographs are taken in various body positions (bending, turning, bending, etc.).

The information content of X-ray diagnostics for diseases of the spine is quite high, but to clarify the diagnosis and identify concomitant diseases and pathologies, additional methods of visualizing damaged tissues are often used: MRI or MSCT (CT).

USDG

Dopplerography of the blood vessels of the spine is auxiliary method and is used to assess the patency of the carotid and vertebral arteries and measure blood flow velocity. This study can be used both to identify specific diseases and pathologies, and to prevent degenerative-dystrophic changes in the tissues of the spine, since nutrition of the intervertebral discs is carried out by diffusion through the vessels of the central spinal canal.

The procedure is carried out using an ultrasound sensor and resembles a regular ultrasound examination.

Electromyography

Electromyography of paravertebral muscles is also used in a comprehensive assessment of spinal pathologies and is used to diagnose pathologies of the neuromuscular system. The method also allows you to determine the prevalence and nature of pathological processes and detect diseases of the peripheral nervous system at an early stage, when conservative correction is most effective.

To conduct the study, cutaneous or intramuscular needle electrodes can be used. For patients with increased sensitivity and a low pain threshold, the procedure can be quite painful, since the sensation from the electrodes resembles an electric shock.

Which method is better?

It is impossible to answer this question correctly, since all diagnostic methods have their own disadvantages and advantages. The final choice always remains with the attending physician, and the decision is made based on the expected diagnosis, the results of a physical and visual examination (including diagnosis of trigger points), the patient’s medical history and existing contraindications. CT and radiography are considered effective methods for identifying pathologies of hard tissues (for example, bones), but if soft tissue defects (hernias, protrusions) are suspected, MRI is a more reliable and informative method.

For pregnant women, only X-ray examination is recommended until the end of pregnancy (if there are significant indications).

Video - Preparing for an MRI of the spine

Examination of the spine is an important task that can be performed for therapeutic, diagnostic or preventive purposes. It is necessary to seek medical help not only if back pain occurs, but also if any possible signs are detected, since many spinal diseases begin with mild severe symptoms. The preferred, but rather expensive method for examining this part of the axial skeleton today is MRI, but if it is not possible to undergo a magnetic resonance scan, you can use other diagnostic methods, after first making sure that there are no contraindications.

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