What MRI will show for spinal osteochondrosis

A common cause of pain in the spine is degenerative diseases, which include osteochondrosis. The pathology is characterized by changes in the intervertebral discs, which lose their elasticity, become deformed and become thinner.

This leads to a narrowing of the intervertebral space and compression of the nerve bundles. The initial diagnosis for clinical manifestations is radiography. What will an x-ray show for osteochondrosis, and at what stage of development of the pathology can changes be visualized?

Osteochondrosis

Are osteochondrosis changes visible on x-ray?

The study helps identify changes in bone structure. Soft tissue elements are not visualized or only gross defects are visible.

Osteochondrosis affects the intervertebral discs, which themselves are not visible with conventional x-ray examination.

Osteochondrosis on X-ray
When a disc degenerates, it becomes compressed (elastic and resilient tissue becomes thinner and loses its shock-absorbing properties), which in the image looks like a narrowing of the intervertebral space. The first sign appears only at the second stage. The first stage of intervertebral disc degeneration will be shown by x-rays of a separate part of the spine in functional tests or fluoroscopy.

For diagnosis, several images are taken in different positions; in conclusion, the radiologist identifies vertebral instability:

• the vertebrae shift in relation to each other forward or to the sides;
• axis deviation between two vertebrae is more than 2 mm;
• An angular deformity is detected in the area of ​​the affected segment of the spinal column - pathological curvature of the axis.

Causes of degenerative spine diseases

Among the “triggers” for the development of degenerative-dystrophic diseases of the spine, the following should be mentioned:

• Aging of osteochondral tissue , loss of moisture and elasticity by the intervertebral discs (accordingly, a decrease in shock-absorbing properties, as well as the height and density of the disc, higher trauma);
• Connective tissue dysplasia (excessive elasticity, fragility, fibrousness);
• Physical inactivity or “sedentary” lifestyle: weak back muscles reduce the intensity of local blood circulation, as a result of which the nutrition of the vertebrae is disrupted;
• Overweight;
• Diabetes; ;
• Primary metabolic diseases (gout, mucopolysaccharidosis, pathologies of protein metabolism);
• Genetic predisposition to DDSD, congenital anomalies of the structure of the spine;
• Infectious and inflammatory processes;;
• Systematic overload , violation of biomechanics (work related to heavy lifting, heavy physical labor, professional sports);
• Injuries, vertebral displacement.

Symptoms on X-ray

In the later stages, a regular photograph reveals the following symptoms and signs:

• narrowing of the gap between the vertebrae;
• Pommer's nodes - multiple notches with a wavy, clear border, indicating prolapse of the disc into the vertebral body;
• marginal growths at the corners of the vertebral bodies (osteophytes) in the affected area - the addition of spondylosis due to friction between the vertebrae, deprived of the disc layer;
• vertebral displacement or listhesis;
• ischemic changes (thinning) of soft tissues;
• instability of the spinal column.

  
  Pommer's knots

What can be seen on an MRI for osteochondrosis?

Thanks to MRI images, the doctor can clearly see pathologies in the intervertebral discs, articular cartilage, problems in connective tissues, pinched nerves, inflammation in the tissues of ligaments and muscles. Based on the results of tomography, neurologists can judge the location of the disease, the degree of osteochondrosis, the presence of a rupture of the nucleus pulposus and the appearance of hernial formations. Tomography data will allow you to diagnose:

• Displacement of intervertebral discs;
• Thinning of the intervertebral discs;
• Condensed formations;
• Salt deposits;
• Inflammation of soft tissues and muscles.
• The appearance of hernias and protrusions;
• Degenerative-dystrophic changes and displacements in the vertebrae;
• Ligament hypertrophy;
• Deformation of the facet joints.

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PROTRUSION

INTERVERTEBRAL HERNIA

Comparison with other diagnostic methods

The first stage of osteochondrosis can be detected using modern diagnostic methods: magnetic resonance imaging or computed tomography with contrast.

Compared to conventional radiography, such methods help to visualize soft tissue formations, which include the intervertebral disc, thereby showing pathology even at the first stage of development. They allow you to confirm complications and predict treatment tactics.

Thanks to axial sections, CT and MRI reveal narrowing of the spinal canal and damage to the neurovascular bundle. Herniated intervertebral discs, their exact location and size are identified. The accuracy of the studies allows the neurosurgeon to determine the method of correcting the pathology.

The safest diagnostic method

What are the types of degenerative-dystrophic diseases of the spine?

A large group of degenerative-dystrophic diseases of the spine are united by at least three characteristics:

• DDSDs are potentially chronic diseases. In the absence of adequate therapeutic and conservative measures, the negative effects increase over time.
• Most degenerative diseases of the spine are associated with the natural aging of osteochondral tissue, but its destruction, thinning, and fragility can also be caused by other reasons (sports or household injury, physical inactivity, metabolic disorders, congenital connective tissue dysplasia).
• Some DDSDs, such as spinal stenosis, intervertebral hernias, and tumors lead to compression of the nerve endings or roots of the spinal cord. This causes a gross disruption of the biomechanics of the human body, muscle atrophy, weakness of the limbs, lameness, as well as intense pain, which can lead to depression.

Depending on the location, it is customary to distinguish degenerative-dystrophic diseases:

• Cervical spine;
• Thoracic spine;
• Lumbosacral spine.

The localization of DDZP influences treatment tactics.

Degenerative-dystrophic diseases of the spine include:

• Osteochondrosis;
• Intervertebral hernia;
• Protrusion;
• Spondylosis;
• Spondyloarthrosis;
• Spondylolisthesis;
• Spinal stenosis;
• Spinal cyst;
• Osteophytes;
• Spondylosis;
• Spinal osteoporosis;
• Sacroiliitis;
• Myofascial syndrome;
• Facet syndrome (facet joint syndrome).

Indications and contraindications for radiographs

Indications for conducting a study to identify osteochondrosis on x-ray are:

• pain in the lumbar region, back, cervical spine;
• limitation of mobility in various parts of the spinal column;
• poor posture: scoliosis, kyphosis, pathological lordosis;
• manifestations of radiculopathy (damage to the lumbosacral region), intercostal neuralgia (damage to the thoracic segment), plexopathy (damage to the cervical region);
• with cervical osteochondrosis, severe headaches, dizziness, darkening of the eyes, tinnitus;
• trophic disorders due to atrophy of the nerve roots (impaired skin sensitivity, the formation of muscle atrophies, the formation of skin ulcers).

Manifestations of osteochondrosis can already appear in adolescence. The peak incidence occurs in females aged 35-40, when degenerative changes are provoked by hormonal changes. With age, the development of pathology becomes more frequent due to a smaller supply of nutrients and calcium leaching. Regenerative mechanisms are depleted, disc destruction occurs faster.

Contraindications to radiography are common to all types of examination. The examination is strictly prohibited for pregnant women; research in children and lactating women is limited. This is due to the ionizing effect of X-rays.

Spinal neoplasms

Spinal tumors can be benign or malignant. The prevalence of the latter is relatively low, and most often it is not bone cancer that is diagnosed, but spinal cord cancer, which paralyzes the entire human body.

As benign tumors grow, they can also have disabling consequences. Neoplasms can compress nerve fibers and roots of the spinal cord, causing pain, neuralgia, and muscle atrophy.

Spinal injuries, bone diseases, and heredity increase the risk of spinal tumors.

Benign tumors of the spine include:

• Osteoma - develops from bone cells in the pedicles of the posterior part of the vertebra. It manifests itself as back pain, which bothers you at night. They are poorly visualized on X-ray; the only accurate method of visualizing them is CT.
• Bone cyst - a tumor forms on the back of the vertebra or affects it completely. Most often found in the cervical spine. If there are compressions, they are removed surgically.
• Giant cell tumors are formed primarily from bone cells and represent a deviation from their normal development. They reach large sizes and therefore cause pain. They are removed surgically and require pre- and postoperative monitoring, as they can degenerate into a malignant tumor of the spine.
• Granuloma is a spinal tumor, usually small in size. Accompanying damage to the vertebra, namely the thinning of its body. Vertebral granuloma can be an independent disease, or it can indicate malfunctions and damage to other organs. Treatment is carried out using surgical or radiation methods.

Malignant neoplasms of the spine include:

• Metastases are secondary foci of oncology, formed from malignant cells that migrated from other organs, bones and joints through the circulatory system or lymph flow. As a rule, the primary focus is located close, and depending on the segment of the spine, it can be the lungs, abdominal cavity, mammary gland, prostate gland, etc.
• Osteogenic sarcoma is a malignant tumor of bone tissue. Common among children (adolescents) and elderly patients.
• Myeloma (or multiple myeloma) is a malignant tumor of bone tissue. Multiple myeloma often affects not only the spine, but also other osteochondral structures. The highest prevalence of the disease is among patients over 40 years of age.

What needs to be examined

To identify osteochondrosis, it is necessary to carry out X-ray diagnostics of the area where the damage is most likely localized. Osteochondrosis is shown by x-ray:

• cervical spine with functional tests;
• thoracic vertebrae;
• lumbar spine in functional tests.

X-rays of the sacrum are not performed, since there are no intervertebral discs anatomically in this section; the image is of little information for diagnosing degenerative pathology of intervertebral discs.

A CT scan revealed a degenerative disease of the spine - what to do?

If back pain does not bother you, but the “accidental finding” on a CT or MRI turned out to be “degenerative-dystrophic disease of the spine,” you should clarify what kind of disease it is and assess the possible health risks in the future.

Timely consultation with a neurologist or osteopath will help develop measures for effective treatment of DDSD and prevention of complications. The worst option would be to ignore the problem and “let go” of the situation to the point of traumatic consequences and the need for surgical intervention.

If there is severe pain associated with an intervertebral hernia, stenosis or other type of DDSD, the patient should consult a neurologist, algologist or neurosurgeon. The pain must be relieved, as it makes it difficult to move and provokes the development of depression, thus aggravating the situation. The patient will also be prescribed therapy (NSAIDs, therapeutic blockades, exercise therapy, radiofrequency ablation, physiotherapy, etc.) or surgery will be recommended.

Complex treatment of osteochondrosis

Effective treatment of osteochondrosis requires an integrated approach, including:

• Diet therapy. Proper nutrition with adequate water regime slows down degenerative processes. Products containing gelatin are useful for discs: jellied fish, jellied meat, jelly.
• Drug treatment. The main groups of drugs necessary to relieve attacks of radiculoneuropathy against the background of osteochondrosis changes are steroidal and non-steroidal anti-inflammatory drugs. Muscle relaxants are used to reduce muscle spasms. They help reduce inflammation and swelling around the nerve roots and reduce pain. Then a course of restorative treatment is carried out using drugs - chondroprotectors containing hyaluronic acid, chondroitin sulfate and glucosamine. Calcium preparations are used to strengthen bone structures and prevent degeneration of bone structures.
• Therapeutic exercise. It is necessary to normalize motor activity, as well as body weight, since obesity increases the load on the intervertebral discs and accelerates their destruction. Physical education helps normalize blood circulation in the affected area and strengthen the muscle corset.
• Physiotherapeutic treatment. With the help of electrotherapy, ultrasound, magnetic therapy, acupuncture and other methods, it is possible to reduce the doses of medications and administer medications locally.
• Massage. It is carried out during the recovery period to enhance blood circulation and activate regenerative processes.

Osteochondrosis is a common disease that affects the intervertebral discs. The primary diagnosis of pathology is radiography of the area.

Unfortunately, the method is not very informative and is capable of visualizing pathology during functional diagnostics only at the second stage. Then clarification is required using modern tomographic studies.

Spinal injuries

Spinal fractures can result from accidents, sports injuries, falls from a height, blows and bruises. Secondarily, they occur against the background of osteoporosis, aggressive growth of hemangiomas or other tumors. It should be noted that not all spinal fractures are visible on x-rays - due to the low resolution and two-dimensional nature of the visualization, the capabilities of this method in diagnosing fractures and injuries are limited. The “gold standard” is considered to be a CT scan of the spine - a high-precision volumetric slice-by-slice scan that allows you to obtain an authentic 3D model of the body area under study.

Spinal injuries are classified into three groups, depending on the severity of the injury:

• Vertebral fractures (compression wedge-shaped, comminuted) without distraction and axial torsion - the spinal cord and important neurovascular components are not affected.
• Fractures of the vertebral bodies with distraction (rupture) of the anterior and/or posterior segments, there are fracture-dislocations, local compression of the spinal cord is possible.
• Vertebral fractures with distraction, displacement (twisting) of the vertebrae, compression of nerve fibers and parts of the spinal cord.

At the moment, computed tomography is the only diagnostic method that provides comprehensive answers about the nature of the bone injury and a complete visual picture.

Diagnostics

• The medical history includes a detailed study of the patient's symptoms, their intensity and the relationship of pain with exercise or body position. Information about regular physical activity, sleep habits, and past injuries is also needed.
• A physical examination is necessary to examine range of motion and muscle condition. The presence of painful areas on palpation or physical abnormalities is also determined. In addition, neurological tests are performed to determine neurological deficits.
• The above diagnostic methods are usually sufficient to diagnose osteochondrosis, but an accurate diagnosis requires the use of imaging methods.
• CT
• Radiography
• MSCT
• PAT
• MRI is a diagnostic method that allows you to clarify the degree of degeneration, the presence of fractures, herniated discs and stenosis. Often, an MRI examination is necessary in preparation for surgical treatment in order to accurately determine the location of the degenerated disc and plan the operation.

Studies have shown that MRI findings of moderate to severe disc degeneration are found in scans of patients with both severe pain and minimal or no pain. In addition, many disease conditions may not show up on MRI. For this reason, the diagnosis cannot be made solely on the basis of imaging results, and verification of the diagnosis is possible only on the basis of a combination of all clinical and instrumental examination methods.

Exercise therapy and activity modification

Exercise is essential to maintaining healthy spinal mobility. An effective exercise program for the lumbar spine should include:

• Stretching exercises for the muscles of the lower back, hips and pelvis, as well as the harmstring muscles. Tightening of these muscles increases pressure on the lumbar spine and contributes to the development of lower back pain.
• Strengthening your lower back and abdominal muscles helps you maintain good posture and better support your spine. A muscle strengthening exercise program may include an individual exercise program, dynamic lumbar spine stabilization, tai chi, Pilates, or others.
• Low-impact aerobic exercise, which increases your heart rate, improves blood circulation and the supply of nutrients and oxygen needed to repair body tissues. For example, this could be walking, swimming and water aerobics.

Exercise programs are usually tailored on a case-by-case basis, depending on your overall health, severity of pain, and personal preference.

In addition, small adjustments to daily activities (lifestyle modifications) can effectively alleviate pain. For example, wearing a brace when lifting heavy objects or avoiding twisting when lifting heavy objects can prevent increased pain due to excessive stress on the discs. Using an ergonomic chair and orthopedic mattress can also improve your posture and reduce stress on your discs.