MRI of a spinal hernia: what a hernia looks like, how an MRI of a hernia is done

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Spinal herniation is a common finding on MRI. Magnetic resonance imaging is a modern detailed screening technique that allows you to obtain accurate information about the condition of all structures of the back. Using this method, neurologists can diagnose various degenerative changes in intervertebral discs, including protrusions, intervertebral hernias, prolapse, and extrusions.

What is an intervertebral hernia?

Intervertebral hernia is a complex pathology of the human musculoskeletal system, in which the anatomy of the spine is noticeably disrupted due to protrusion of the core of the intervertebral disc into the spinal canal as a result of a violation of the integrity of the fibrous ring. The danger of this condition lies in the pressure of the hernia on the membrane of the spinal cord, which can lead to paralysis. Prolapse sometimes affects the nerve roots, and the patient begins to feel severe pain. The process of disc destruction that accompanies intervertebral hernia slowly but inevitably leads to disruptions in the functioning of the entire musculoskeletal system. Therefore, to preserve the quality of life and health, one must strive to diagnose hernial formations at the initial stage of their formation (protrusion stage) and, if possible, stop further degradation of the vertebral discs with the help of preventive treatment.

• MRI
• Ultrasound

MRI tomograph:

Siemens Magnetom C

Type:

Open (expert class)

What's included in the price:

Diagnostics, interpretation of images, written report from a radiologist, recording of tomograms on CD + free consultation with a neurologist or orthopedist after an MRI of the spine or joint

Ultrasound machine

HITACHI HI VISION Avius

Class:

Expert (installation year 2019)

What's included in the price:

Diagnostics, interpretation of images, written diagnostic report

Treatment of spinal hernias without surgery in Moscow

Since the formation of bulging intervertebral discs is associated with the occurrence of disturbances in the functioning of internal organs, patients most often turn to therapists, who are not always able to look at the problem more broadly and suspect the presence of disorders in the spine. Therefore, patients often receive long-term therapy aimed at eliminating the consequences of degenerative changes in the spine, but not themselves.

Of course, it is important and justified, but isolated exposure leads, at best, to a temporary improvement in the condition. In order to achieve lasting positive changes in the patient’s well-being, complex therapy is required, which will primarily be aimed at eliminating the spinal hernia and only after that at the resulting consequences from the internal organs.

Therefore, as part of the treatment of spinal hernia without surgery, the following complex is prescribed:

• drug therapy;
• osteopathy;
• massage;
• manual therapy;
• physiotherapy (phonophoresis, carboxytherapy, ozone therapy);
• individual sessions with a rehabilitation specialist;
• diet.

It is important to avoid lifting heavy objects, and office workers are encouraged to move more during the day.

Drug therapy

Patients are prescribed a complex of medications designed to eliminate pain, improve the trophism of cartilage tissue and eliminate the inflammatory process. For these purposes, drugs from the following pharmacological groups are selected:

• NSAIDs that exhibit analgesic and anti-inflammatory properties and are available in the form of drugs for oral use, for topical use, etc.;
• muscle relaxants that help eliminate increased muscle tone and the resulting pain, which is often observed with the formation of intervertebral hernias;
• corticosteroids, which have pronounced anti-inflammatory properties and are used for serious inflammatory processes in the area of ​​intervertebral discs (injected into the epidural space exclusively in medical institutions);
• B vitamins, which help improve the transmission of bioelectric impulses from the spinal cord to the corresponding organs;
• vitamin D is a remedy responsible for the condition of bone tissue, as well as for higher brain functions, such as memory, memory, attention, speech;
• chondroprotectors that contribute to the saturation of cartilage tissue with its structural elements (chondroitin and glucosamine). We recommend Mermaids Marine Collagen to our patients;
• psychotropic drugs necessary to increase the effectiveness of NSAIDs and muscle relaxants, as well as eliminate psychological problems caused by the long-term persistence of certain restrictions due to pain;
• biostimulants are used to increase the intensity of metabolic processes.

For each patient, the doctor individually selects not only a list of necessary medications, but also their dosages. Additionally, therapy is prescribed for existing diseases of internal organs. At the same time, it is important that all medications are correctly combined with each other and do not inhibit each other’s actions or provoke a worsening of the condition.

For example, the use of NSAIDs should be treated very carefully in the presence of diseases of the stomach and duodenum, since they have a fairly pronounced ulcerogenic effect. Therefore, if there is no way to refuse them, the doctor may recommend replacing the tablets with rectal suppositories or injectable forms of drugs.

Monitoring appointments are required to evaluate the effectiveness of the treatment and, if necessary, adjustments are made.

For patients with very severe pain, blockades may be prescribed. To perform them, solutions of novocaine and lidocaine are used, sometimes with the addition of corticosteroids. The procedure involves the injection of an anesthetic solution into a strictly defined point in the area of ​​the affected spinal motion segment of the spine in the area of ​​the passage of the nerve that provokes the appearance of pain.

Blockades can only be performed in a medical facility by specially trained medical personnel, since the slightest errors in the manipulation technique can lead to severe neurological complications. The procedure produces almost immediate results, so the patient can immediately return to daily activities, but it does not have a therapeutic effect. In addition, it is recommended to perform no more than 4 blockades annually. Therefore, not every attack can be stopped with their help.

Manual therapy

Manual therapy is one of the mandatory and very effective methods of treating spinal hernias without surgery. With its help, you can not only improve the quality of blood flow in the affected area, which will help increase the amount of nutrients entering the intervertebral discs, but also eliminate pain, as well as limitations in mobility.

Moreover, manual therapy, carried out according to the author’s method of A. Gritsenko, can effectively eliminate compression of the nerves and thereby eliminate the very cause of disturbances in the functioning of internal organs, which was mentioned above.

A. Gritsenko’s method is absolutely unique. It has been used in practice for about 30 years and has allowed many patients to avoid surgical intervention, as well as completely restore their own health.

Today, only a few people know this method, since its use does not require the blind application of generally accepted techniques, but a targeted, jewel-precise impact on specific areas of the spine. As a result, the chiropractor is able to eliminate the existing deformity, reduce pressure on the spinal cord, release the nerves and provide a quick, and most importantly, lasting improvement in the condition.

But manual therapy sessions can only be trusted by a qualified specialist who has the appropriate license and considerable practical experience. Otherwise, there is a risk of aggravating the situation and increasing the size of the protrusion.

Physiotherapy

Individually selected courses of physiotherapeutic procedures help to increase the effectiveness of the treatment, reduce the severity of pain and help increase the mobility of the affected spinal motion segment. Most often, traction therapy is used for spinal hernias. This method involves stretching the spine using a dry or underwater method.

In the first case, the patient lies down on a special couch, fastening belts are put on him and a static tensile load is created using the device. He spends a certain time in this position, after which wearing an orthopedic bandage may be recommended.

With the underwater method, the procedure is carried out in a similar way, but all manipulations are performed in water. In both cases, there is an increase in the distance between the vertebral bodies, which leads to the elimination of increased pressure on the intervertebral discs and the creation of favorable conditions for their restoration. Also, by traction of the spine, it is possible to release the pinched nerve roots, which leads to the elimination of neurological symptoms.

Patients may also be recommended courses of the following procedures:

• electrophoresis is a physiotherapeutic procedure that involves the use of electrical impulses to ensure the penetration of drugs directly into the lesion;
• ultrasound therapy - the procedure helps to activate metabolic processes in both bone and cartilage tissue, as well as the lysis of dense calcifications;
• UHF is a method that involves the use of dry heat in the projection of the affected area, which has a beneficial effect on the quality of nutrition of the disk and starts the processes of its recovery;
• laser therapy - the procedure has a similar effect to UHF, but additionally helps reduce the risk of infection.

In some situations, it is acceptable to perform certain physical therapy procedures at home. But for this, patients need to purchase or rent special devices.

Exercise therapy

Therapeutic exercise is designed to increase the tone of the muscle corset, which will create reliable support for the spine when performing everyday work. A set of exercises for each patient is developed individually by a rehabilitation physician, taking into account his level of physical fitness and the location of the pathological protrusion of the disc.

Exercises should be performed daily. The load is increased gradually and only on the recommendation of the attending physician. But if pain occurs during exercise, you should immediately stop and consult a specialist.

Diagnosis of hernia using MRI

A spinal hernia is detected on MRI even in cases where obvious external symptoms are not observed. The fact is that with an MRI of the spine, the research step is very small. It is only 2-3 mm. This level of detail allows the doctor to see the most minor deviations and anomalies of the spinal column. Using tomography, it is possible not only to understand in which part of the spine ruptures and prolapses of the nucleus pulposus occurred, but also to determine exactly what negative changes the patient has that increase the risk of developing a hernia. Negative factors include:

• signs of osteochondrosis;
• protrusion - the disc protrudes into the spinal canal, the integrity of the fibrous ring is not impaired, but there is a possibility of worsening the patient’s condition;
• violation of the correct position of the nucleus pulposus - it is displaced into the spinal canal and damage to the fibrous ring.

Diagnostics

Today, the only research method that can provide comprehensive information about the condition of intervertebral discs is magnetic resonance imaging or MRI. It is safe for the patient and at the same time makes it possible to identify the slightest deviations in the “shock absorbers” of the spine, including minor protrusions.

The study can be carried out using two types of devices:

• Closed - classic MRI machines with a retractable couch and a hollow tube in which a magnetic field with a power of 1.5 to 3 Tesla is created. They are not suitable for patients suffering from claustrophobia.
• Open - the device does not have a solid tube, which increases the level of comfort for patients who are afraid of closed spaces, but at the same time reduces the information content of the study, since in such devices the magnetic field power does not exceed 0.2–1.2 Tesla.

During the procedure, it is important to remain completely still, otherwise it will not be possible to obtain a clear image, and the information content of the study will be reduced. On average, an MRI takes 20 minutes, but the method cannot be used to examine people with metal structures or elements in the body (with the exception of titanium).

Sometimes, to qualitatively assess the condition of bone structures, patients are also prescribed an X-ray or CT scan of the spine. They are also used when it is impossible to perform an MRI for one reason or another. With the help of CT and X-rays, it is possible to assess the height of the discs, detect signs of osteoporosis, osteophytes, spinal fractures, including fused ones, instability of spinal motion segments and anomalies.

In our clinic, you can also learn in more detail about the composition of your body and the state of the vascular system, which is involved in the blood supply to internal organs, skeletal muscles, and the brain. Our experienced doctors will explain the data obtained to you in detail. Bioimpendansometry calculates the ratio of fat, muscle, bone and skeletal mass, total fluid in the body, and basal metabolic rate. The intensity of recommended physical activity depends on the state of muscle mass. Metabolic processes, in turn, affect the body's ability to recover. Based on the indicators of active cell mass, one can judge the level of physical activity and nutritional balance. This simple and quick test helps us identify disturbances in the endocrine system and take the necessary measures. In addition, it is also very important for us to know the condition of blood vessels for the prevention of diseases such as heart attacks, hypertension, heart failure, diabetes and much more. Angioscan allows you to determine such important indicators as the biological age of blood vessels, their stiffness, stress index (which indicates heart rate), and blood oxygen saturation. Such screening will be useful for men and women over 30, athletes, those undergoing long-term and severe treatment, as well as everyone who monitors their health.

In this case, body composition analysis gives us information that adipose tissue predominates in the body, and the musculoskeletal component is in relative deficiency. These data will help the rehabilitation doctor competently draw up a physical activity plan, taking into account the individual characteristics of the patient.

What does a hernia look like on an MRI of the spine?

On MRI images, a hernial protrusion appears as a protrusion of the nucleus pulposus, a structure between the vertebrae. On tomograms, the radiologist sees a “blurred” nucleus pulposus and a decrease in the distance between the vertebrae. Depending on where the hernial protrusion is directed, the tomography evaluates nearby structures: whether there are signs of spinal cord canal stenosis or compression of the nerve roots. The hernia can be local or sequestered. Sequestered hernia is the most severe form of intervertebral disc damage. With this pathology, a large fragment of the disc core substance falls out and is completely separated from it. On MRI images it looks like a piece of the hernia itself lagging behind.

Depending on size

Depending on what stage the protrusion is at, pathologies are divided into:

• Protrusion or prolapse. The size of the hernia is no more than three millimeters, can be considered a physiological norm and does not cause any unpleasant symptoms.
• Prolapse. The second, pathological degree, the formation reaches six millimeters and begins to cause pain.
• Extrusion. The bulge can be up to one and a half centimeters in size and causes severe pain. The functions of internal organs are impaired, the quality of life decreases.

Why does a hernia form?

Every day a person loads his spine. Sometimes this load turns out to be excessively high, and the spinal column begins to lose a sufficient level of strength and flexibility. There are many reasons why a herniated disc occurs. For example:

• traumatic impact;
• being overweight;
• infections that affect the spinal column;
• lack of movement, sedentary lifestyle;
• degenerative processes that have arisen in the vertebrae and discs;
• congenital spinal abnormalities;
• changes associated with spinal curvature.

Causes of hernia between vertebrae

Pathology occurs for three main reasons:

• Increased stress when working or playing sports.
• Injuries.
• Changes in tissues due to the patient's age.

The cartilage ring of the disc becomes thinner over time, and the amount of fluid in it decreases. The aging of the body is inevitably accompanied by pathological processes in the discs; the tissue wears out. This is due to upright posture, which puts constant stress on the spine. If nutrition is poor, the diet lacks essential substances, and physical activity and activity are generally minimal, the process goes even faster.

Hernias of the cervical and lumbar spine on MRI

Hernias can form in any part of the spine, but the lumbosacral region (150 cases per 100,000 people per year) and the cervical spine are most often affected by this pathology. Its sizes vary, which allows us to classify intervertebral hernias into the following types:

• median;
• lateral;
• posterolateral;
• anterolateral;
• combined (combined).

Regardless of the location, type and cause that caused the hernia, all patients ultimately get the same result - an inflammatory process and swelling of the tissues. The hernia grows gradually and at the initial stage of its formation does not cause pain. Further, these pathological changes are accompanied by mild discomfort, and later constant pain occurs. Clinical manifestations of an intervertebral hernia will be: pain in the lower back (if a hernia appears in this section), sometimes radiating to the buttocks, weakness and numbness of the legs, and there may be difficulty urinating. If the hernia is localized in the cervical or thoracic regions, its symptoms will be pain radiating to the shoulder, frequent dizziness in combination with high blood pressure.

If you observe the appearance of any of the above symptoms, you should contact a neurologist who will conduct an initial examination. Based on its results, the specialist can recommend clarifying diagnostic studies. An MRI is usually the recommended way to detect a herniated disc.

By localization

There are three localization options:

• Hernia of the cervical spine. It is painful for the patient to move his head, turn and tilt it. In this case, the pain radiates to the arm and back at the level of the shoulder blades. There is also numbness and weakness in the hands.
• Hernia of the thoracic spine. There are girdling pains, loss of coordination of movements, decreased tone, and there may be urinary disorders.
• Hernia of the lumbar spine. At any stage, protrusion is accompanied by pain. If the hernia is small and does not put pressure on the spinal cord, pain occurs periodically, increases with loads and activity, and with uncomfortable body position. When the size of the hernia increases, the symptoms intensify and lumbago appears. There are difficulties with straightening the back, limbs become numb, and tingling becomes more frequent. At this stage, the shape of the spine changes, and the functions of the excretory and reproductive systems are disrupted.

Schmorl's hernia

This is the name for an anomaly in which the cartilaginous tissue of the end plates ends up in the spongy bone of the vertebrae. Pathology can manifest itself in a child during a period of increased bone growth. Soft tissue develops faster than bone, which leads to the formation of voids in the vertebrae. This problem in a child is detected exclusively during an MRI. This pathology in itself is not dangerous, but the Schmorl node indicates a risk of developing a hernia in the future and a high probability of compression fractures of the spine. This warning should not be ignored - if this anomaly is detected in your children, you should definitely listen to the doctors’ recommendations for preventive treatment.

MRI or CT scan of the spine for a hernia - which is better?

CT and MRI of the spine are diagnostic procedures with certain differences between them. In appearance, a computer tomograph and a magnetic resonance imaging scanner are very similar, but the scanning principles in them are different. MRI is based on the effect of nuclear magnetic resonance. A computed tomograph is an advanced X-ray machine whose operating principle is based on the ability of X-rays to pass through human tissue. Both types of diagnostics are very informative, but each has its own strengths. Thus, during an MRI of the spine, soft and cartilage tissues are more clearly displayed in the images. The same can be said for lymph nodes and blood vessels. A CT scan is indispensable if necessary to determine the location of bleeding and diagnose neoplasms in bone tissue, as well as identify salt deposits. Because magnetic resonance imaging is a better image of soft tissue, MRI is better suited for diagnosing the herniated disc itself and its impact on the nerve roots and spinal cord. It will be possible to evaluate the hernia on CT images only by secondary signs, for example, by changes in the distance between the vertebrae.

When choosing a method for diagnosing the spine, the safety aspect of the examination also plays a role. The magnetic field of the tomograph is completely harmless to humans, therefore magnetic resonance imaging can be performed more often than CT, in which there is a certain danger in the form of radiation, and it should be done no more than 1-2 times a year. For the same reason, computed tomography is not prescribed to certain categories of patients - children, women carrying a child, and people who have recently undergone fluoroscopy or radiography.

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What program should I use to open MRI images?

MRI: fracture of the odontoid process of the second cervical vertebra (sagittal plane, T2 VI)
To open MRI images, you will need a special program (DICOM Viewer, RadiAnt, etc.), which can be downloaded on the Internet. Sometimes there is a file on the electronic media to install the application: run it following the instructions.

You must insert the CD into the drive or memory card into the appropriate slot on the computer. With the latter, a problem may arise due to the lack of a suitable connector; in such a situation, additional components will be required - a card reader and a USB cable.

After connecting the electronic media, you need to wait a while - the operating system must detect the disk or card and install the driver. An autorun program will appear on the screen in which you should open the folder to view files. If this does not happen, go to the “Start” menu, select “My Computer”, after the window appears, find “Devices with removable storage” and left-click on it.

You can view photos of an MR procedure as individual images or as a series of frames.

MRI and Hernia: Frequently Asked Questions

How to determine a spinal hernia without an MRI?

First of all, it is worth noting that such an opportunity does not always exist. If the doctor can determine the diagnosis even before a tomographic examination, then the situation is already advanced. A large intervertebral hernia makes itself felt by severe back pain, a feeling of numbness in the limbs, pain when moving, migraines and dizziness. In any case, you cannot do without an examination, because it is during an MRI scan that the following is determined: the width of the spinal canal, the degree of damage, the size and location of the hernia. Without tomography, the diagnosis may be incorrect.

Is it possible to diagnose a herniated disc on an MRI?

When the doctor evaluates the MRI image of the spine, the hernia is visible very clearly. A specialist can accurately identify the existing problem. On tomographic scans, all structures of the spine will be clearly visible: the soft tissues with which it is surrounded, spinal nerve trunks, intervertebral discs.

Is it common to find a spinal hernia on MRI?

According to statistics, a herniated disc is found in 220 people out of 100,000 people. In almost half of all cases, the formation is localized at the level of L5-S1 or L4-L5 of the lumbosacral region. If you regularly undergo examinations and monitor the condition of your spine, your risk of developing this disease to a condition requiring surgical intervention is low. The most important thing here is early diagnosis.

How often should an MRI be done for a herniated disc?

The doctor decides this issue. But, as mentioned above, due to its painlessness and safety, the number of tomographic procedures is not limited. MRI can be performed at any time interval.

Author: Kasimov Evgeniy Tulkunovich

Neurologist with 8 years of experience

Preparation

Urgent MRI can be performed without prior preparation. If you have a planned MRI, doctors recommend familiarizing yourself with some features of the procedure:

• If contrast administration is required, you must come to the procedure with an empty stomach, having refused to eat 5-6 hours before the examination.
• It is not recommended to drink too much liquid before the examination to avoid discomfort inside the tomograph.
• Remove all metal jewelry from your body in advance: earrings, rings, piercings, etc.
• If the hernia was diagnosed earlier, take the results of the study with you.
• If you feel fear or anxiety before getting tested, consult your doctor.