Each segment of the spine is of great importance for the normal functioning of the entire spinal column and spinal cord, since the stability of each segment depends on other vertebrae and discs and, only in this way, the spine can function fully. Over time, the spine is subject to constant stress, injury or other impacts, and is susceptible to various diseases such as disc degeneration, vertebral degeneration, arthritis, etc. These conditions can cause pain and dysfunction.
spinal diseases , but the most common are a number of diseases that are clinically significant.
Ankylosing spondylitis (Bechterew's disease). This disease is a type of arthritis in which chronic inflammation of the joints of the spine and sacroiliac joints occurs. Initially, inflammation occurs in the sacroiliac joints, then moves to the spine, leading to stiffness and limited mobility. With prolonged inflammation of the joints of the spine (spondylitis), calcium deposits are formed in the ligaments around the intervertebral discs, which leads to weakening of the discs and a decrease in their shock-absorbing and support functions. As calcium deposits accumulate in the ligaments, there is a significant decrease in both range of motion and flexibility in the spine. The disease can progress to fusion of the vertebrae, which is called ankylosis. As a result of ankylosis, the spine loses mobility, the vertebrae become fragile, and the risk of vertebral fracture increases. In addition to damage to the spine, ankylosing spondylitis leads to disruptions in the functioning of other organs, since the disease is systemic.
Osteochondrosis
Over time, the spine is subjected to daily stress and minor injuries, which ultimately leads to wear and tear of the intervertebral discs and their degeneration. The fibrous ring of the intervertebral disc is damaged under load, micro-tears of fibrous tissue occur, and then the damaged area is replaced by scar tissue, the elastic properties of which are much worse than those of fibrous tissue. Such changes in the annulus fibrosus lead to decreased shock-absorbing function of the disc and a greater risk of recurrent disc ruptures. As the annulus fibrosus becomes scarred, the gelatinous part of the disc (nucleus) also gradually shrinks, which in turn leads to a decrease in disc height. As the height of the disc and shock-absorbing functions decrease, the vertebrae begin to exert more pressure on each other under load, which leads to the formation of bone growths (osteophytes). Violation of the integrity of the fibrous ring leads to the formation of disc herniations. Disc herniations and osteophytes can cause compression or stenosis, leading to neurological symptoms.
Computed tomography (CT)
This method uses a narrow beam of X-ray radiation, which illuminates the desired object and is captured at the output by receiving equipment. All data enters the computer, which processes it, builds an image and displays it on the display. To obtain complete data, the patient is filmed while the system rotates around his body, and recording is carried out at all phases of rotation. This method allows you to see the vertebrae, intervertebral discs, ligaments, blood vessels, and soft tissues. As a result, tomograms can detect deformations of the meninges, ruptures of disc contours, compression of nerve roots, and so on. This method is used to photograph small segments of the body and is usually prescribed after an x-ray to clarify the condition of a specific suspicious intervertebral disc. Let us add that the dose of x-ray radiation during tomography is much higher than when taking a conventional x-ray.
Spinal stenosis
Stenosis is a narrowing of the space in the spine where the spinal cord and spinal roots pass. The space of the spinal canal, as a rule, is initially not very large, especially in the cervical and thoracic spine, but with various pathological changes in the spine it becomes critically small. These can be either degenerative changes in the spine or injuries. Significant narrowing (stenosis) of the spinal canal leads to a compression effect on the spinal cord, which will be manifested by pain, weakness in the limbs, sensory disturbances, and in severe cases, dysfunction of the bladder and intestines. Many older people have spinal canal stenosis to varying degrees. Unlike a disc herniation, in which compression of one or two nerves occurs and a picture of radiculopathy occurs, with stenosis, compression occurs on many nerves simultaneously and this condition is called myelopathy. For stenosis, conservative treatment is possible if the symptoms are moderate. If there are severe neurological symptoms, then surgical treatment is usually recommended, the purpose of which is to decompress the spinal cord.
Ultrasound Dopplerography (USDG)
This method is used to study the blood supply to the brain (for example, to study the patency of the arteries that supply the brain). The basis of the method is the Doppler effect, which consists in the fact that if an object moves, the frequency of the signal from it changes. These objects during ultrasound examination are blood particles. The system sends out an ultrasonic signal that is reflected from these moving particles, and changes in its frequency are the data that are processed by the computer and make it possible to judge the patency of the vessels. The method is absolutely safe and very effective, and therefore is widely used for diagnosing vascular changes that occur due to spinal osteochondrosis.
Herniated disc
A herniated disc occurs when the annulus fibrosus that surrounds the intervertebral disc ruptures. This rupture causes the central portion of the disc, which contains a substance called nucleus pulposus, to be released. When pressure is applied to the vertebrae above and below, the nucleus pulposus comes out, puts pressure on nearby nerve structures and causes severe pain and nerve damage. Disc herniations most often occur in the lumbar spine and are sometimes called disc extrusion.
Passive and active treatment
There is a definite difference between passive and active treatment. Initially, these treatments can be used in combination to restore the patient's mobility more quickly, but in the long term, active treatments have a more lasting effect on the health of the spine.
Passive treatment
Passive techniques are used initially to reduce pain so the patient can prepare to resume activity. These procedures, such as ultrasound, TENS, etc., are aimed at reducing pain, while the real treatment is to restore the correct pattern of movements by strengthening the musculo-ligamentous system.
Active treatment
The active part of treatment is physical exercise, including stretching, strengthening and endurance components. Stretching helps improve flexibility and range of motion. Weight or resistance exercises are necessary to increase muscle strength. Strengthening muscles helps relieve stress on the spine and joints. Strengthening the spinal column is of particular importance for the treatment of back diseases. The so-called “dynamic stabilization” helps reduce the vectors of force loads on the spine, discs and nerves. To improve endurance, long repeated movements are used - this increases resistance to aerobic exercise and also reduces pain.
Radiculopathy
The term radiculitis (radiculopathy) is widely used and means root compression. Radiculitis can occur in both the lumbar and cervical spine, or much less frequently in the thoracic spine. Root compression occurs when there is excess pressure on the nerve root. Excessive pressure can come from both bone tissue and soft tissue (muscles, cartilage, ligaments). This pressure disrupts nerve function, causing pain, tingling, numbness, or weakness.
Osteoporosis is a disease in which bone tissue, including the vertebrae, weakens, which increases the risk of vertebral fracture, even with minor loads. Vertebral compression fractures are the most common type of fracture caused by osteoporosis, and hip and wrist fractures are also possible with osteoporosis. These vertebral fractures can change the shape and strength of the spine, especially in older women, who often develop spinal deformity as a result of such fractures. The spine becomes excessively tilted in the thoracic region (kyphosis) and the shoulders bulge forward. With severe osteoporosis, even simple movements such as bending forward can lead to vertebral fractures.
Contraindications
If the patient has metal implants, then the doctor must be warned about this at the first consultation. MRI is prohibited if the patient has:
- cochlear implant;
- built-in pacemaker;
- intravascular metal elements;
- metal plates, pins, screws, clips, surgical staples;
- artificial heart valve;
- neurostimulator;
- limb prostheses or joint replacements.
In addition, there are some other limitations for MRI.
Thus, overweight patients (more than 120 kg) cannot be examined in closed-type capsules, since closed tomographs have technical limitations on the diameter of the tunnel and overweight patients may not fit in them. There is an alternative option for them: open-type tomographs, which can also be used to examine patients who suffer from claustrophobia.
Children, people with claustrophobia and people with increased nervousness are given sedatives before the examination, since any movement during the examination is prohibited.
For the same reason, patients with schizophrenia, Huntington's disease, Parkinson's disease, or other diseases that cause involuntary body movements may not have the procedure.
If the patient experiences pain, then before the examination he is given local anesthesia or anesthesia (depending on the condition).
Spinal fractures
The vertebrae have great strength and can withstand a lot of pressure, while at the same time the spine does not lose flexibility. But like other bones in the body, they can break under extreme excess pressure, injury or disease. In such cases, damage or fractures to the vertebrae can range from minor to severe.
Compression fractures
As the name suggests, compression fractures occur from excessive axial loads that compromise the integrity of the vertebral body. Osteoporosis is one of the leading causes of compression fractures, as there is a decrease in the ability of the vertebrae to withstand stress. In such cases, even a slight fall or even a cough can lead to a compression fracture. People often perceive back pain as a normal part of aging, and sometimes compression fractures go unnoticed. Repeated compression fractures can lead to a decrease in spinal height. Another common cause of a compression fracture is trauma, such as a fall.
Often, vertebral compression fractures will eventually heal on their own (without treatment). NSAIDs (for example, aspirin) may be prescribed to relieve pain. For severe fractures, surgical methods (vertebroplasty and kyphoplasty) may be used.
Burst fractures
Blowout fractures usually occur after severe trauma (for example, a car accident or a fall from a height). Blast fractures are significantly more dangerous than compression fractures because the anterior and middle portion of the vertebral body is fractured into multiple fragments and is more likely to result in spinal cord injury. Additionally, as the vertebral body loses its integrity, the spine becomes unstable. In some cases, with burst fractures, if there is no impact on the spinal cord, conservative treatment can be performed. If there are loose fragments or damage to the nerve structures, then surgical treatment is necessary.
Flexion-extension fractures
Such fractures are sometimes called Chance fractures and occur during sudden flexion-extension. Most often, this type of injury occurs in car accidents, in people wearing a seat belt, and not only fractures of the vertebrae, but also ligaments, discs, and sometimes internal organs. Such fractures are usually unstable and require surgical treatment. This type of fracture occurs in 5-10% of cases of spinal fractures.
Vertebral fracture with dislocation. Such fractures occur when exposed to great force, and not only the integrity of the vertebral body is violated, but also its displacement (due to rupture of ligaments and discs). Such fractures often require surgical intervention.
Fractures are also divided into stable and unstable. Compression fractures are generally considered stable and do not require surgery. In contrast, unstable fractures (eg, burst or Chance fractures) typically require surgical treatment, often as an emergency.
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
Spinal deformities
Spinal column deformity means any significant deviation from the normal curves of the spine. The most common are
- Scoliosis
- Hyperkyphosis
- Hyperlordosis
There are various causes of pathological curvature of the spine. Some children are born with congenital scoliosis or congenital hyperkyphosis.
Sometimes nerve and muscle diseases, injuries, or other conditions cause spinal deformities (such as cerebral palsy).
Most often (up to 80-85%) scoliosis is “idiopathic” (without an obvious cause). Idiopathic scoliosis develops gradually but can progress rapidly during the growing years of adolescence.
Scoliosis
The term scoliosis was first used to describe this spinal deformity by Hippocrates in 400 BC. It is a progressive disease with an unknown cause (idiopathic) in 80% of cases, although there is evidence that genetics and nutrition play a role. Women are 10 times more likely to develop scoliosis than men. Scoliosis is often accompanied by twisting of the spine, which leads to deformation of the costal arches and chest. Scoliosis usually begins to appear during adolescence. Conservative treatment is quite effective for grade 1-2 scoliosis. In cases of severe deformation (grade 3-4) and in cases of progressive scoliosis in adolescence, surgical treatment is recommended (the earlier surgical treatment is performed, the better the long-term results).
Hyperkyphosis
Mild kyphosis is the natural curvature of the thoracic spine, while hyperkyphosis is an excessive forward tilt of the thoracic spine (slouching). Hyperkyphosis is common in older people and is usually associated with the presence of osteoporosis and previous vertebral compression fractures. Causes of hyperkyphosis can also be injuries, diseases of the endocrine system and other diseases. In adolescence, hyperkyphosis may occur, such as Scheuermann-Mau disease, which is characterized by a wedge-shaped deformation of three or more vertebrae in the thoracic spine. As a rule, conservative treatment for Scheuermann-Mau disease is quite effective, but when the angle of deviation from the axis is more than 60 degrees, surgical treatment is recommended.
Hyperlordosis
Lordosis is a natural inward curve in the lumbar spine, and hyperlordosis is a pathological increased curve in the lumbar spine. Hyperlordosis is usually accompanied by an abnormal anterior tilt of the pelvis and is often accompanied by excessive protrusion of the buttocks. Symptoms may include pain and numbness if there is compression of nerve structures. As a rule, hyperlordosis is caused by weakness of the back muscles, hyperextension, for example, in pregnant women, in men with excessive visceral fat. Hyperlordosis is also associated with puberty.
Treatment for hyperlordosis is usually not required unless nerve structures are affected.
Ankylosing spondylitis (ankylosing spondylitis)
This is a systemic inflammatory disease that affects all spinal structures. Inflammation begins in the sacroiliac joints, then spreads higher, developing in an ascending line. Over time, calcium deposits appear in the ligaments, which leads to a decrease in mobility and flexibility. Without treatment, ankylosing spondylitis progresses, and gradually the vertebrae fuse together: ankylosis occurs. The first symptoms are dull pain and stiffness in the lower back, which intensifies in the morning and decreases after physical activity and a hot shower. During the day, the pain is stronger at rest; when a person moves, it subsides. In the later stages, posture noticeably deteriorates.
Spinal tumors
Spinal tumors are quite rare. Tumors can be benign or malignant. Primary malignant tumors of the spinal cord are very rare. Malignant spinal tumors are usually metastatic in nature and have a primary focus in other organs and tissues.
From a clinical and anatomical point of view, tumors can be classified as epidural, intradural extramedullary and intramedullary tumors.
Metastatic tumors of the spine are the most common for bone metastases.
The most common solid tumors secondary to the spine are breast, prostate, and renal carcinoma, which account for almost 80% of spinal metastases. Tumors of unknown primary origin account for about 5% -10% of cases. Metastases of neoplasms of the hematopoietic system account for about 4% -10%.
How is an MRI of the back muscles done?
The study is carried out both on an outpatient basis and when the patient is hospitalized in an inpatient department. The patient is changed into a hospital gown (in some cases it is allowed not to change clothes if they are loose enough and there are no metal elements on them), placed on a retractable table, which is later pushed into a magnetic capsule. Using special belts and bolsters, the arms, chest and head are secured, since movement is strictly prohibited during the examination.
The device itself contains a two-way intercom so that the radiologist can talk to the patient, give him the necessary instructions, and also so that the patient can report changes in his condition, ailments, nausea, dizziness, difficulty breathing or any strange sensations . In such cases, scanning is forced to stop. But do not be alarmed by the sensations of slight tingling or warmth in certain areas of the body - this is considered absolutely normal.
Since the magnet makes quite a lot of noise, for the comfort of patients, headphones are most often provided to drown out the noise. Some models of tomographs have the ability to turn on calm music, which will not only relieve the patient from noise, but also help to calm down and relax.
All medical personnel must leave the room before starting the scanner.