Spinal examination methods

The desire to examine a patient as fully as possible often leads doctors to prescribe examinations that duplicate each other in the nature of the information obtained. For each specific patient, the scope of examinations should be determined individually, and it is always desirable to prescribe those examinations that are most informative for solving a specific diagnostic problem. Therefore, we considered it necessary to provide a description of the most frequently used examination methods in vertebrology with a list of the main tasks that can be solved with their help. The description of the methods is not given in alphabetical order, but in accordance with the actual frequency and significance used.

Survey radiography (standard spondylography) is a basic method of radiological examination and is performed in a lying position in two projections. The examination is performed with maximum coverage of the entire spine, and on the anteroposterior radiograph - also the wings of the iliac bones. The method allows:

• to roughly assess the condition of the spine;
• calculate the magnitude of spinal deformation in the frontal and sagittal planes, and approximately estimate the magnitude of torsion (pathological rotation) of the vertebrae;
• to roughly assess the condition of the paravertebral tissues;
• determine the degree of maturity of the skeleton (according to the Risser tests and the state of the apophyses of the vertebral bodies);
• to roughly estimate the size of the spinal canal.

Computer tomography (CT) is most informative for assessing the bone structure of the vertebrae in a limited number (one or two) of vertebral segments, primarily in the posterior parts of the bodies, arches and processes (transverse, articular, spinous). Visualization of the state of paravertebral tissues at the level of the area of interest is possible. In combination with contrast myelography (CT + myelography), the method is used to assess the patency of the cerebrospinal fluid pathways, the state of the spinal canal and, approximately, the spinal cord in the area of interest.

Magnetic resonance imaging (MRI) is most informative for:

• visualization of the spinal cord, its reserve spaces (subarachnoid and epidural), the spinal canal as a whole and at the level of the area of interest (transverse slices);
• disk visualization;
• early detection of pathology accompanied by microcirculatory disorders in the spine and not detected by other methods of radiation diagnostics;
• assessment of the state of paravertebral tissues.

Functional radiographs - performing anteroposterior and lateral spondylograms with maximum permissible movements: in the frontal plane - with lateral bends, in the sagittal plane - with flexion and extension. Used to determine the natural mobility of the spine.

X-ray tomography - the execution of layer-by-layer X-ray sections allows to clarify the nature of pathological changes in the vertebrae and paravertebral tissues, and to evaluate the structure of the vertebrae.

Spondylurography is a combination of spondylography with simultaneous contrasting of the urinary tract. It is usually used when there is a suspicion of concomitant pathology of the urinary system in children with congenital vertebral defects. Simultaneous assessment of the condition of the spine and urinary tract allows to reduce the overall radiation load during the examination.

Myelo(tomography)graphy - examination of the spinal canal with the introduction of contrast agents into the subarachnoid space allows:

• visualize the subarachnoid space and determine its patency;
• to visualize the spinal cord;
• identify extradural and extramedullary formations that impair the patency of cerebrospinal fluid pathways;

Echospondylography (ESG) is an ultrasound examination of the spine and spinal canal. The method is indispensable for prenatal diagnostics of spinal malformations, and is also used for an approximate assessment of the condition of the spinal canal;

Epidurography is a study of the spine and spinal canal with the introduction of contrast agents into the epidural space.

Venospondylography (VSG) is a study of the spine with contrasting of the epidural and paravertebral venous pathways. The contrast agent is injected into the bone structures of the vertebra (usually into the spinous process). The condition of the venous epidural plexuses is assessed. The method can be used for early detection of volumetric formations in the epidural space.

Radioisotope scanning of the skeleton is a study of the activity of metabolic processes in bone tissue by recording the accumulation of an osteotropic radiopharmaceutical (RFP); it allows detecting pathological bone foci with active metabolism (inflammatory, some tumors).

Discography is a contrast study of the intervertebral disc. It is currently used in polysegmental discopathy as a provocative test to identify the segment causing the pain syndrome.

Thus, depending on the diagnostic task, the importance of one or another research method changes significantly:

• to determine the type and extent of spinal deformity, the most informative are standard spondylography and spondylo-urography;
• to assess the structure of the bone elements of the spine - CT, X-ray tomography;
• to assess the condition of the discs - MRI, discography;
• for visualization of the spinal cord and its reserve spaces - MRI, CT myelography, myelography, epidurography;
• for prenatal diagnosis of spinal diseases and its approximate visualization in young children (screening) - echospondylography;
• to detect hemodynamic disturbances in the vertebrae - MRI;
• for early detection of solid and systemic tumor lesions of the spine (pre-radiological stage), assessment of their prevalence in the vertebral segments and skeletal system - radioisotope scanning, MRI;
• to assess the epidural and paravertebral venous pool - venospondylography.
• to assess the condition of paravertebral tissues - MRI, CT, X-ray tomography.

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