home Audience 4 Examination of a patient with diseases of the spine. Algorithm for examining the spine and spinal cord - European recommendations The role of radiation diagnostics in examining the spine

Examination of a patient with diseases of the spine. Algorithm for examining the spine and spinal cord - European recommendations The role of radiation diagnostics in examining the spine

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 the entire available medical complex of means.

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 make an accurate diagnosis and 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: a spine of normal structure, a flat back, a stooped back, a 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 the sensitivity of the 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:

Most modern doctors strive to resort to research methods such as myelogram, radioisotope scanning, disc and venospondylography as little as possible, since they are invasive techniques, and their disadvantages include possible individual intolerance and allergic reactions to the administered radiocontrast substances.

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 a wide range of diagnosed problems, complete painlessness and high speed of 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 of the 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 diagnosing pathological changes in 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 a 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, but in pathological areas, insufficient or excessive accumulation occurs, 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 in the human body, they 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. Taking cerebrospinal fluid to examine and measure intracranial pressure is called a lumbar puncture.

Laboratory examination of lumbar puncture allows us to determine the presence of a brain tumor, subarachnoid hemorrhages, various infectious lesions of the 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 a separate diagnostic test and call it 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 of 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 from our experienced specialists - vertebrologists, osteopaths, traumatologists, surgeons, chiropractors, to conduct a full diagnosis of their musculoskeletal system and receive effective qualified medical care. Our spine treatment center in Moscow is fully equipped with all the necessary examination equipment.

Pain in the back is a common complaint and the first symptom of the disease. Spinal pathologies lead to a deterioration in the quality of life and are a catalyst for diseases of many internal organs and systems of the body. It is important not only to know how to check the spine and determine the diagnosis, but also to do this at the initial stage of the disease, and in the future strictly adhere to the doctor’s recommendations in order to avoid the development of the disease or its exacerbation.

Alarm Signals

By the age of 30, a rare person can boast of the absence of back pain. More often, a situation arises when people think about how to check the spine in order to find the cause of the ailment much earlier. More than 80% of the world's population suffers from back problems.

The most common pathologies are osteochondrosis, intervertebral hernia, scoliosis and radiculitis. Where can I get my spine checked? With such problems, contact any medical institution - a clinic at your place of residence, a private consultative and diagnostic center, an outpatient clinic, etc. Specialists in the issue of back diseases are vertebrologists and orthopedists; for certain indications, a visit to a neurosurgeon or neurologist is required.

They develop almost imperceptibly, but at one, far from wonderful moment, a sharp pain occurs. For a specialist, such a symptom is eloquent - it indicates an exacerbation of the disease, while the patient did not even suspect that he was sick. If you pay attention to the body’s signals, it is not difficult to identify the onset of the disease.

For what pains or conditions should you consult a doctor to find out how to check the spine and find the source of the disease:

Injury
Symmetrical or only on one side of the body numbness of the limbs.
Localized in any pain.
Frequent headaches, dizziness.
A sharp drop in visual acuity and hearing.
Unmotivated and fainting.
Nagging pain of unknown origin in one or both legs.
Restriction of mobility of any part of the body.
Decreased sensitivity in the limbs.

There is also a layer of symptoms that indirectly indicate problems in the spine, for example, pain in the heart, difficulty breathing, weakening of memory, loss of orientation and many other seemingly unexpected signs. Such symptoms may signal diseases of those organs indicated by the signs, or may be the result of pinched nerve roots emerging from the spinal column.

Who to contact

To dispel doubts and get an accurate picture of the condition, you need to contact a specialist. You can make an appointment with a doctor at a clinic or outpatient clinic of any form of ownership. If your health has reached a critical point, then hospitalization is necessary. Specialists in a hospital setting will quickly make a diagnosis and be able to prescribe treatment. It is better not to reach this state, as irreversible consequences may begin.

Which doctor checks the spine? Pathologies of the musculoskeletal system, and primarily the spine, are dealt with by specialists:

Orthopedist.
Neurosurgeon.
Vertebrologist.
Neuropathologist.

A vertebrologist can consider the problem from any point of view, since his specialization is diseases of the spine. Unfortunately, specialists in this area are still poorly represented in clinics.

Determine intervertebral hernia

A herniated disc causes a lot of trouble, pain and is considered one of the most dangerous diseases. The pathology is accompanied by destruction of the fibrous ring and protrusion of the disc, as a result of which the nerve roots are pinched. In some cases, the disease can force a person into a wheelchair.

If left untreated, inflammation of the nerves and swelling of surrounding tissues occurs at the site of the lesion. Subsequently, dysfunctions appear, destruction of the organ to which the compressed nerve is directed. A herniated disc is always accompanied by acute pain at the site where the nerve is pinched and spreads along its entire length.

How to check for a hernia in the spine? First of all, it is necessary to determine the location of the pain and the symptoms of the pathology:

A hernia in the cervical region is accompanied by dizziness, sudden changes in pressure, and headaches. Pain syndrome may also occur in the upper limbs and shoulder girdle, and sometimes numbness of the fingers is felt.
If the hernia is in the thoracic region, while maintaining a static position for a long time, pain occurs in the chest, often in the heart area.
A hernia in the lumbar region is a pain syndrome in the back or side of the thigh, often spreading to the ankle. Numbness of the toes, pain in the lower leg, lower back, numbness in the groin area and pain in the gluteal muscle.

Diagnostics

How to check the spine for a hernia in the hospital? First of all, consult a doctor, he will conduct a visual diagnosis and, based on its results, give directions for the following types of diagnostics:

Radiography. The study is done in two projections (full face, profile). Allows you to determine the causes of the development of pathology - injuries, developmental anomalies, acquired deformities. Contraindications: pregnancy, intense bleeding.
CT scan. CT allows you to assess the condition of each part of the spine and disc, obtain accurate data on the size of the lesion, make an early diagnosis of the incipient process, and detect the causes that led to the damage. Contraindications: pregnancy, obesity (weight over 150 kg), claustrophobia, inappropriate patient behavior.
Magnetic resonance imaging- the most popular and informative type of research. Using MRI, a specialist examines the condition of the spine and surrounding tissues, the spinal cord, nerve roots and individual discs, assesses the general condition of the spine, finds the causes of damage, and can accurately determine the location of the hernia, its size, and the degree of inflammation of the nerves and tissues. Contraindications - any implants (pacemakers, prostheses, tattoos with metallic inks, electric ear prostheses, Ilizarov apparatus, etc.).
Invasive CT myelography- computed tomography with the introduction of contrast agents around the spinal cord to determine the degree of its compression and the movement of cerebrospinal fluid. This type of study is only available in a hospital setting. Contraindications are the same as for conventional CT, as well as allergies to contrast agents.

Symptoms of neck diseases

To decide how to check the cervical spine, you need to identify the area where the pain is localized and pay attention to the symptoms:

Frequently recurring neuralgia in the neck area.
Pain in the heart, fainting, headache, numbness or loss of sensation, cold fingers, sudden jumps in blood pressure.
Nagging pain moving from the neck to the shoulder blades, shoulder girdle, unreasonable tension in the muscles of the shoulders and cervical region. The pain syndrome intensifies with sudden movements, which significantly limits motor activity.
Periodically occurring muscle spasms, weakness of the upper limbs or overexertion.
Manifestations of neurological symptoms - “frost on the skin”, “goosebumps”, decreased sensitivity and temperature of the extremities, impaired motor skills of the fingers.
Manifestations of tinnitus, decreased vision, dizziness, headaches.

Most often, the patient experiences a complex of symptoms indicating damage to the cervical spine. A detailed diagnosis and professional examination by a doctor will help you make the right conclusion and begin treatment.

Diagnostics for the neck

Patients go to the hospital with already manifested signs of the disease; most often, the symptoms indicate an exacerbation or intensive development of the pathology. Early detection of the disease is diagnosed during medical examinations, which should be taken regularly; in this case, the disease is stopped at the stage of the first changes.

How to check the cervical spine:

The specialist collects an anamnesis of the patient’s complaints.
An external examination is carried out, palpation of the cervical spine, determination of the condition of the vertebrae (protrusion, retraction, displacement relative to the axis, etc.).
The patient is prescribed tests - X-ray, MRI or CT.

A special feature of the study of diseases of the spine in the cervical region is the mandatory recording of an electrocardiogram. This type of diagnosis confirms or rejects vein compression.

Scoliosis: manifestations

It is sometimes difficult to suspect scoliosis; often it is simply not noticed for a long time. In childhood, parents may notice that their child is stooped, lifts, there is noticeable asymmetry of the protruding shoulder blades, deformation of the chest and many other external manifestations of changes in the spine. The child may complain of back pain; he gets tired quickly if he sits or stands in a static position for a long time.

There are several degrees of severity of spinal damage, different types of curvature relative to the straight axis and a number of other features in determining the type of pathology. Mild scoliosis does not cause symptoms, does not complicate daily life activities, and can only be detected at a doctor’s appointment or after screening.

Tests to determine scoliosis

How to check spinal curvature using tests:

The patient is asked to take several steps on his toes, then on his heels, and alternately hop on one leg. The physical test demonstrates balance and development of leg strength. Visually, the doctor assesses the length of the lower extremities, looking for hard tendons in the back of both legs. The specialist checks reflexes, testing neurological disorders, nerve sensations, and muscle functions.
How to check In a hospital setting, curvature is determined using a scoliograph. Most doctors believe that a scoliograph determines the presence of a problem, but it is impossible to determine the degree of deformation with its help, so further diagnosis is carried out using other methods.
In childhood, patients undergo the Risser test to determine the completion of tissue ossification. It allows one to determine the maturity of bone tissue (biological age) and the end of the development of scoliosis. The method is based on determining the degree of ossification of the ilium.

The severity of scoliosis and its treatment strategy are determined by the degree of spinal curvature (more than 11 degrees) and the angle of rotation of the body (ATR). According to medical observations, patients with complaints of scoliosis begin from the moment when the curvature of the spine reaches 30 degrees, and the ATP is at least 7 degrees.

Visual diagnosis of scoliosis

The technical equipment of modern clinics provides several options for visual diagnostics. All methods used are informative enough to determine the degree of curvature of the spine and assess damage to surrounding tissues and organs.

How to check the spine using modern methods:

X-ray. It is considered the most effective method for detecting scoliosis. The screening provides a complete visual picture, and the patient is registered. Children under medical supervision are screened once every few months. Tracking the development of pathology helps determine the severity of the lesion. Identify hyperlordosis, kyphosis, determine the achievement of maturity for bone tissue.
MRI. Diagnostics are prescribed to identify disorders of the spinal cord trunk (occurs in childhood). MRI is also prescribed before surgical interventions to identify congenital features or pathologies in order to avoid complications.

Which doctor checks the back (spine) for scoliosis? Patients with this diagnosis are seen by an orthopedist or vertebrologist. With intensive progress of the pathology, the patient may begin to experience dysfunction of internal organs, which requires additional consultations with specialized specialists (pulmonologist, gastroenterologist, cardiologist, etc.). Scoliosis is treated with surgical and conservative methods; the choice depends on the degree of development, severity, and cause of the disease.

Home diagnostician

Even if you know where to check your spine, the question often arises as to whether it’s the problem if your back hurts. Perhaps the person the day before was engaged in hard work that was unusual for him, in this case there will be fatigue and slight muscle tone in the lumbar region and shoulder girdle. In a couple of days, if there are no illnesses, everything will return to normal.

If the pain syndrome does not go away within a week, stiffness of movements appears, it is difficult to straighten up, a focus of pain has become apparent, nagging pain appears in the leg and the symptoms do not go away after a night’s sleep, it is necessary to find out what is causing the condition.

How to check your spine at home:

With an intervertebral hernia, the patient takes unnatural positions - this partially relieves the pain syndrome that always accompanies the destruction of the intervertebral disc and irritation of the nerve roots. The most common form of exacerbation of this pathology is radiculitis. Also, intense pain appears with awkward, sudden movements.
Checking the spine of a child and an adult for manifestations of scoliosis is quite simple - you need to carefully examine the posture. In a person with curvature, you can see shoulder blades that protrude unnaturally or are located at different levels, the waist line will not be parallel to the ground, and the head may deviate from the straight axis. Also a sign of scoliosis is asymmetrically located shoulders and hips; the general position of the body gravitates towards one side.
Almost no one thinks about how to check the spine in the cervical region. When a crunch, stiffness, and later pain in the neck appears, it becomes clear that there is a problem, and it is necessary to consult a doctor for a verdict and prescriptions for treatment.

Experts are unanimous in their opinion that it is necessary to see a doctor much earlier than the disease knocks you down. With early diagnosis and conservative treatment, exacerbations practically do not occur; it is almost always possible to maintain full mobility and continue to live a normal life.

Everyone knows a way to early diagnose various diseases - this is medical examination. In the process of multidisciplinary research, diseases are detected at an early stage. The preventive examination procedure allows you to examine many organs and systems of the body, including checking the spine. MRI, CT, X-ray are effective tools in the hands of an experienced specialist. With early diagnosis, the patient avoids the aggravation of most diseases.

An experienced doctor can assume the presence of a pathology only on the basis of the patient’s complaints, however, to make a correct diagnosis, an examination of the spine is necessary. There are many methods for diagnosing diseases of this part of the body, but often the most complete picture is provided by a combination of several studies. Let's consider their main types in more detail.

Back pain is such a common problem that many people ignore it. Meanwhile, it is the first sign of many spinal diseases, which over time can not only deprive a person of the opportunity to play sports, but also lead to complete immobility.

Diagnosis of spinal diseases in Russia

Spinal diseases are among the most dangerous and complex. But this does not mean that they are rare - on the contrary, back diseases are very widespread. Most often, doctors diagnose osteochondrosis, herniated discs, radiculitis, scoliosis, kyphosis, cervical spondylosis, narrowing of the spinal canal, and injuries.

Spinal diseases are not only a problem for older people. Children these days are increasingly complaining of back pain. The statistics are amazing: according to the results of medical examination of the children's population of the Russian Federation, carried out in 2002, spinal dysfunction was detected in 30% of preschool children and 95% of high school students. This leads not only to worse results in physical education, but also to problems with concentration - and, consequently, to a decrease in academic performance.

Among adults the situation is no better. Our country is among the “leaders” in the number of spinal diseases, and this is definitely not an area where we want to be the first. It is impossible to determine the exact number of Russians suffering from spinal pathologies - the majority prefer not to pay attention to alarming symptoms and not undergo diagnostics. According to WHO, 80% of the population suffers from clinical manifestations of spinal column diseases. In Russia, most of the time of outpatient appointments with neurologists and orthopedists is occupied by patients with spinal diseases. The reason for such a wide spread of such diseases is the wrong lifestyle. The world is becoming more and more convenient, but this entails sad consequences. Excessive use of gadgets, lack of interest in sports, long hours that we spend sitting - in the office, at home and in the car - all this leads to the fact that our musculoskeletal system begins to work differently than nature intended. This situation is the same for all developed countries. Moreover, the higher the standard of living, the more back problems there are.

Basic methods of studying the spine

To determine the condition of the spine today, many methods are used, both invasive and non-invasive. The most widely used imaging diagnostic methods allow the doctor to examine the spine and determine what pathology he is dealing with.

Neurological examination

The first stage of diagnosis. Its purpose is to study the reflexes and sensitivity of the skin. Damage to a specific part of the spine always affects reflexes and sensitivity in different parts of the body. A neurological examination of the spine is carried out using a rubber hammer, with which the doctor taps the areas where the spinal nerves pass. The sensitivity of the skin is checked by lightly tingling with a special needle.

X-ray studies

What non-specialists call simply “X-ray” is in fact a whole complex of various examinations. X-ray provides accurate information about pathological changes in the spinal motion segment; it is used both for diagnosis and for monitoring the effectiveness of treatment. There are several methods of x-ray examination:

Survey radiography in two projections to assess the shape and structure of the vertebrae, the height of the intervertebral discs, the presence of displacements and curvatures, changes in the spinal canal.
Survey radiography in oblique projections is used to diagnose intervertebral foramina.
Plain radiography with functional tests (flexion, extension) reveals disc instability.
Sight radiography provides the clearest image of two or three vertebrae.
Layer-by-layer X-ray examination (tomography) shows the condition of the spinal canal.
X-ray with contrast (pneumomyelography, myelography, discography, epidurography, venospondylography) provides a clearer image and is extremely valuable for diagnosis.

When examining the spine, it is better to use digital radiography, since this method gives less radiation exposure and is considered safer and more informative. But, nevertheless, doctors try not to prescribe radiography for children and pregnant women unless absolutely necessary.

MRI diagnostics of the spine

The magnetic resonance imaging method is a safe and highly accurate way to examine the condition of the spine, which is based on the phenomenon of nuclear magnetic resonance. The patient does not receive radiation exposure during the examination. MRI can detect pathology not only in bone tissue, but also in soft tissues, for example, in intervertebral discs. The test itself is safe, although some patients may experience nervousness from being in the confined space of the scanner (this can be resolved with sedation or using an open scanner). However, MRI has contraindications: since the scanner is a very powerful magnet, the study is not performed on patients with pacemakers, ferromagnetic or electronic implants and hemostatic clips. All metal accessories should be removed before the examination.

By the way
Some cosmetics, such as mascara and eye shadow, contain small amounts of metal. Therefore, to ensure absolute accuracy of MRI results, women are advised to come for examination without makeup.

CT

Computed tomography is a radiation X-ray research method. This examination is usually prescribed to assess the condition of bone structures. Very often, a CT scan is performed after an MRI examination of the spine has revealed pathological changes. Computed tomography is the most informative for assessing the bone structure of the vertebrae in a limited number of vertebral segments. CT has few contraindications (they are the same as for X-ray analysis). This examination is not recommended for children, pregnant or breastfeeding women.

Ultrasound diagnostics

An absolutely safe method, especially valuable because it provides an image in real time, and not as a static snapshot. Therefore, ultrasound of the spine is often used to monitor biopsy or puncture. Doppler ultrasound is used as a diagnostic method - examination of the vessels of the neck. Doppler ultrasound is necessary to diagnose intervertebral hernias in the cervical spine.

Electromyography

Electromyography allows you to evaluate how well the motor nerves are functioning. Spinal diseases are often accompanied by neuropathies, compression of individual nerves and their injuries. Electromyography shows which nerve is damaged and where exactly. In addition, this method is used for metabolic or inflammatory damage to nerves due to diseases of the spine, lesions of the spinal cord and brain. To conduct electromyography, very thin needles are inserted into the muscle, then the patient, at the request of the doctor, contracts the muscle, and sensors record electrical activity. Despite some invasiveness, the method is safe and practically does not cause discomfort, since the needles used are much thinner than injection needles.

Which method is most accurate and reliable?

All methods of diagnosing the spine are informative, but most often several examinations are performed to make a diagnosis. Of course, patients want to know which methods of diagnosing the spine are better. But doctors themselves do not divide them into “good” and “bad”. They prescribe the type of research that is necessary in each specific case.

In recent years, magnetic resonance imaging has become widespread - this type of diagnosis gives very accurate results and high-quality images, it has few contraindications and does not cause any harm to health even with multiple examinations. However, it is not as cheap as ultrasound and x-ray examinations.

X-rays are widely used to diagnose pathologies of bone structure, but soft tissues are very poorly visible on X-rays. Therefore, X-ray, like CT, is used to diagnose displacements, curvatures and fractures, but it is not suitable for detecting a hernia - in such cases, MRI is prescribed.

Be that as it may, choosing the type of diagnosis is not the task of the patient, but of the doctor, who prescribes examinations based on the expected diagnosis.

Tuesday, 04/10/2018

Editorial opinion

Regular back pain, decreased sensation in the limbs, unexplained headaches - all these and many other symptoms may indicate problems with the spine. Ignoring these “bells” is very risky, because according to statistics, diseases of the musculoskeletal system are one of the main causes of disability.

Spinal diseases are among the common pathologies that can occur in people of different ages. It is necessary to begin examining this part of the musculoskeletal system if a person has back pain, discomfort in the lower back or impaired movement. Currently, research methods are being identified that make it possible to accurately diagnose and begin treatment aimed at preventing complications.

Indications for examination

The patient needs to seek help from specialists for additional diagnostics and clarification of the diagnosis in the presence of various pathological symptoms. This is especially important with the development of frequent headaches, dizziness, impaired sensitivity of the limbs, as well as a decrease in their strength. These conditions may be associated with various diseases in the spine, early detection and treatment of which can improve the prognosis and avoid serious complications.

In addition, indications for conducting an examination of the spine are traumatic effects in the back area and the development of signs of an inflammatory reaction. In childhood, the doctor may prescribe additional methods to confirm the pathology if the presence of congenital structural anomalies or is suspected.

Preparation rules

Spinal examination in most cases does not require mandatory preparation. All the features of the upcoming technique are outlined by a specialist. This eliminates the receipt of false information, which leads to an erroneous diagnosis. X-ray examination of any part of the spine involves the removal of metal products. For CT or MRI scans of the lumbar region, you must avoid eating foods that cause gas for 24 to 48 hours.

Important! Against the background of intestinal bloating, it is recommended to take up to two Espumisan tablets the day before.

When performing studies with a contrast agent, it is prohibited to eat food for several hours before the procedure. For pregnant women, you must first consult with an obstetrician-gynecologist. It evaluates safety for the fetus and potential risk.

Stages

Before choosing the most necessary research methods, it is important for the doctor to assess the patient’s condition and make a preliminary diagnosis. Following the main steps allows you to achieve a positive result by identifying the cause of complaints. The standard diagnostic scheme includes:

Conversation with the patient and subsequent external examination. The doctor initially clarifies the information about what worries the person, as well as the presence of diseases, taking medications and the dynamics of the process. It is necessary to exclude congenital malformations of the spine, previous injuries and surgical interventions. One of the main techniques used to assess the condition is palpation. In this case, it is possible to identify not only curvatures, but also tumor formations, traumatic deformities, inflammatory processes and the condition of surrounding tissues.
Exclusion of diseases from other parts of the musculoskeletal system. Back pain is not always caused by spinal problems. In most cases, its source is foot disorders with signs of flat feet or curvature of the lower extremities. Pathological symptoms develop as a result of uneven distribution of load on the overlying sections, in particular on the lower back.
Prescription of additional diagnostic methods. Choosing the most optimal method to make a diagnosis is based on several principles. The main one is the severity of the patient. At the initial stages of the disease, available studies, such as radiography, are used. The data obtained allows the doctor to assess the overall picture and diagnose in more detail areas that require attention.

Based on the examination, a plan for further examination of the patient is determined.

Radiography

This technique is one of the most common. It is used as a primary stage to assess the condition of the spine. This is explained by the availability of devices in most medical institutions, the relatively low cost, as well as the training of specialists in deciphering the received images. Scanning allows you to obtain an image in only one projection; it can be direct, lateral or oblique. This explains the lack of accuracy in the presence of pathological conditions at the initial stage.

X-rays are shown to reveal traumatic injury, vertebral displacement, osteophytes, as well as indirect signs of inflammatory processes and tumor growth. If necessary, perform functional radiography during flexion, rotation, or tilt. The technique is not highly informative; with its help it is possible to identify only pronounced changes.

This diagnosis of the spine does not take a long time. Therefore, contraindications for use are based on exposure to radiation, which can be dangerous during pregnancy. It is also necessary to delay its implementation in case of a life-threatening condition until it stabilizes.

Contrast x-ray techniques have the greatest accuracy, among which are:

Pneumomyelography. After this is completed, air is injected into the area of the spinal canal with a volume of 20 to 40 ml.
Angiography. In this case, a contrast agent is injected into the carotid or vertebral arteries, while simultaneously taking a series of pictures with the resulting staining.
Discography. The drug is administered to the area of a specific disc, which is a possible source of pathological symptoms.
Myelography. A less common study based on the injection of a dye into the area of the subarachnoid canal. This is necessary in order to highlight the spine as clearly as possible. The procedure is quite painful, which requires local anesthesia. The patient, who is in a supine position, is turned in a vertical plane to move the coloring agent. The pathological focus can be recognized based on the resulting difference in pressure.

CT scan

A study based on the effects of x-rays on bone and surrounding tissue. Scanning allows you to take pictures at a short distance. As a result, the doctor receives a large number of sections stored electronically. Their superposition on each other leads to the formation of a three-dimensional image that reveals pathological changes in the early stages. The technique has limitations due to the radiation exposure that affects the body. Compared to radiography, it has higher accuracy.

Among the main contraindications for implementation are:

Pregnancy at any stage.
Human body weight that exceeds 120 kg. Large medical centers are equipped with devices designed to diagnose heavier patients.
The presence of severe mental illness.

Due to the need for a long stay in a forced position, the doctor must explain the procedure in detail at the consultation stage. This will help eliminate possible complications, fear and discomfort that a person may experience.

Magnetic resonance imaging

The study consists of the effects of electromagnetic radiation on bone tissue, muscles, blood vessels and nerves. The resulting image is three-dimensional. It is used to identify neurological, oncological, and degenerative diseases of the spinal column. Unlike computed tomography, the technique does not expose the body to radiation, which makes it possible to expand the list of indications for its use. High cost limits use in clinical practice.

The main contraindications limiting the use of the technique include:

heart failure in the stage of decompensation;
the presence in the body of pacemakers, defibrillators or insulin pumps of various generations;
installed hemostatic clips;
metal structures installed in the spine area;
pregnancy during the first trimester.

The patient must first notify the doctor about the presence of installed dentures with metal components, stimulants of the nervous system, as well as tattoos with dyes containing metal.

Electromyography

A non-invasive technique based on the study of impulses that emanate from nerve fibers. It is indicated for suspected pathologies associated with changes in the neuromuscular system. It must be used in conjunction with other studies to exclude diseases caused by lesions of the peripheral nervous system.

Attention! Identifying them in the early stages allows you to achieve an effect with the help of conservative therapy and avoid irreversible changes.

During this procedure, electrodes are installed on the surface of the skin either cutaneously or intramuscularly. If the patient has increased sensitivity or a high pain threshold, the procedure may cause discomfort, which is comparable to pain from low-frequency electric shock.

Doppler ultrasound

This non-invasive method is based on the reflection of ultrasound waves from tissues of different densities. It is used to assess blood flow in the carotid and vertebral arteries, measure its speed characteristics, and also determine the degree of lumen with possible narrowings or the presence of blood clots. Malnutrition causes the development of degenerative processes in the muscles of the spinal column, discs and bone tissue. Early detection of changes allows treatment to begin at the initial stages of the disease.

Ultrasound examination of blood flow in the spine can determine the cause of headaches.

What's better?

It is difficult to determine which diagnostic method is the most effective and reliable for checking the spine; each of them has its own characteristics of impact.

X-rays are now used less and less, since compared to computed tomography or magnetic resonance imaging, its accuracy is less. The advantage of its purpose is its speed of execution, wide availability and low cost.

To determine the required tomography method, it is necessary to take into account that the magnetic resonance method allows identifying predominantly soft tissue structures, which is important for diagnosing intervertebral hernias or diseases of the nervous system. It can be prescribed to pregnant women with restrictions. There is no harmful effect on the body. Computed tomography is most often used for lesions in the skeletal system. In many ways, its limitations are related to the radiation exposure provided.

Conclusion

Timely diagnosis of spinal diseases makes it possible to eliminate the pathological symptoms that bother a person. In order to find out the cause of this condition, it is necessary to seek help from a specialist as soon as possible. Early examination not only improves the quality of life, but also prevents the formation of complications.

According to statistics, more than 70% of all people on earth complain of back problems. The cause of pain can be serious pathologies of the spine, which significantly worsen the quality of life of the person suffering from them.

In order to get rid of pain, it is important to make an appointment with a doctor for an examination, who will conduct a series of diagnostic measures.

Diagnosis of the spine is an important procedure that allows you to see the full picture of the condition and the cause of back pain.

When should the spinal column be examined?

Back pain can be caused by a number of reasons, which are not always possible to find out without diagnostic measures.

If pain in the spinal column does not go away for a long period, you need to make an appointment with a specialist for a thorough diagnosis.

The sooner the cause of pain is found out, the easier it will be to eliminate this problem. An examination of the spinal column is recommended for any degenerative processes or injuries.

It is important to make an appointment when back pain is accompanied by other symptoms, such as urinary incontinence or limb insemination. The doctor will tell you in more detail about how to check your back and, based on all the symptoms, will select the most appropriate method of examination.

If the doctor suspects congenital anomalies and pathologies of the spine, he will prescribe instrumental diagnostic methods.

You should not postpone a visit to the doctor if pain in the back persists for more than 2-3 weeks, in this case there is a high probability that the disease will develop into a chronic form, which will be much more difficult to cope with.

Preparation for the examination: is it necessary?

The most appropriate examination of the spine is prescribed by the attending physician after a complete medical history. Preparation for it depends on the choice of diagnostic procedure and the part of the spinal ridge being studied (cervical, thoracic or lumbar).

For example, when preparing for an examination of the lumbar region, it is recommended not to consume foods that cause increased formation of gases in the intestines for 3-4 days.

These include: fermented milk products (milk), black bread, vegetables (potatoes and cabbage). If the patient complains of bloating, he is prescribed activated charcoal.

Also, if the patient is very worried before the procedure, he needs to take a sedative so that the picture does not turn out blurry

Thanks to examinations, it is possible to identify any diseases of the spinal column in the early stages. For example, an examination of the spine makes it possible to recognize the onset of an intervertebral hernia, since it clearly shows the displacement of part of the deformed intervertebral disc.

Diagnostic methods

Unfortunately, many people experience various back problems. Diagnosis of the back is necessary in order to recognize the cause of discomfort.

Most often they occur as a result of degenerative-dystrophic diseases of the back (for example, damage to the intervertebral discs or cervical osteochondrosis).

They are characterized by the following symptoms:

numbness of the lower and upper extremities (impaired sensitivity);
cracking joints;
painful sensations, both during movements and at rest;
dizziness and the appearance of “floaters” before the eyes;
“ringing” in the ears, significant deterioration of vision.

To schedule an examination for back pain, you must consult a specialist. This issue is dealt with by neurologists and orthopedic doctors. They will tell you in more detail about how to check the spine and what diagnostic methods exist.

Today there are many ways to study the spinal column. Diagnosis of the back is carried out using laboratory and instrumental methods.

Using modern diagnostic methods, it is possible to diagnose malignant and benign neoplasms (for example, spinal cord tumors), vertebral displacement and spinal diseases of infectious origin.

Let's take a closer look at the most popular methods of studying the spine.

Radiography

If you experience discomfort in your back, you should consult a specialist who will prescribe further diagnostics of the spine. The most common among
instrumental diagnostic methods are radiography.

The patient lies down on the couch, and special equipment (X-ray machine) films the desired area (cervical, thoracic or lumbar).

Also, using the device, it is possible to obtain images (x-rays) of the entire back.

Images are obtained in two projections using x-rays. It is a black and white image with areas of different color intensities. With the help of modernized equipment, the image in the photograph can be taken at 10x magnification.

X-ray examination allows you to clearly see curvatures, pathological fractures (cracks and displacements of bones), malignant neoplasms (darkening with clear boundaries), determine the amount of deformation of the spinal column and establish the stages of various systemic diseases.

The procedure is painless, lasts about 4-6 minutes, and does not require careful preparation.

Within 40 minutes, the doctor will give the result and conclusion, which will describe the condition of the back in detail. For preventive purposes, X-ray examination is used no more than once a year.

The main contraindication for this procedure is pregnancy (in any trimester). This is due to the fact that there is a high probability of a negative effect of X-rays on the development of the fetus. Also, diagnosis is not carried out if the patient’s condition is serious.

If we are talking about contrast radiography, then the list of contraindications increases significantly, these include:

increased sensitivity to contrast agents;
diabetes mellitus in the stage of decompensation;
lactation period;
serious infectious diseases (for example, tuberculosis);
severe liver and kidney diseases.

Magnetic resonance imaging (MRI)

MRI is a more informative method, the essence of which is to examine the spine using electromagnetic radiation.

Currently, improved open-type tomographs are being produced, thanks to which even people with a fear of closed spaces can undergo examinations.

This procedure does not harm the body, since there is no exposure to ionizing radiation.

Magnetic resonance imaging is prescribed when radiographic examination is not enough to determine the correct diagnosis and fully assess the condition of the spinal column.

Using MRI of the back, you can recognize the presence of vascular malformations, Schmorl's hernia, inflammation of muscles and ligaments, back deformities, and spinal cord damage.

The tomograph takes pictures from several angles, which are immediately displayed on the monitor.

Let's take a closer look at how the spine is examined using magnetic resonance imaging. During the procedure, the patient should not have any elements with metal.

Its duration is about 25 minutes (depending on the area being examined), during which time the patient should lie quietly on the couch without making any movements. Any activity can distort the result.

Contraindications to MRI include: the presence in the body of electronic devices (pacemakers), metal elements (clips, prostheses), the need for continuous resuscitation measures.

Computed tomography (CT)

Diagnosis of spinal diseases is also carried out using computed tomography, which is based on the effects of X-rays.

In comparison with radiographic examination, it is more informative, since it can be used to obtain images of tissues in layers, identify the degree of damage to structures (both cartilaginous and bone), compression of the s1 root, and see in detail changes in the spine.

The procedure is carried out similarly to magnetic resonance imaging: the patient lies motionless on the couch for 20 minutes. There are no absolute contraindications to the procedure, but there are relative contraindications, these include childhood and pregnancy (due to the influence of rays).

Which type to choose - differences

All modern diagnostic methods are quite informative and allow a specialist to make an accurate diagnosis. Magnetic resonance and computed tomography are more reliable diagnostics of spinal diseases compared to radiography, and therefore are prescribed for serious pathologies of the spinal column.

If we consider methods for their effect on the body, then the most harmless and safe is MRI, since there is no penetrating radiation.

When your lower back hurts, the examination cannot be postponed.

Diseases in the lumbosacral region are very common. This is due to the fact that the lower back tends to become deformed when a person sits for a long time. The muscles stop bearing the load, and the lumbar vertebrae begin to compress the intervertebral discs.

Video

Spine diagnostics

Where can I get the procedures?

When your back hurts, you can get examined by a doctor in specialized medical centers. In public clinics there are neurologists and orthopedists who can conduct an initial examination and prescribe further examination.