X-ray of the cervical spine with functional tests

The cervical spine is the most mobile part of it, experiencing tremendous stress every day, which often leads to injuries and deformities of the vertebrae. The fact is that in this segment the muscular apparatus is somewhat weaker than in other areas of the spine. As a result, muscles, vertebrae, ligaments, and even brain tissue suffer, due to the blockage of blood flow by deformed vertebrae and spasmodic muscles. Often, to determine the cause of a malfunction in the body, it is necessary to conduct an x-ray of the cervical spine - this is an affordable, accurate and fast diagnostic method for detecting basic disorders in the musculoskeletal system. [1]

Indications for the procedure

In what cases the doctor can insist on an X-ray of the cervical spine:

• for pain in the neck, if their origin is unknown, or is questioned;
• with pain or recurrent numbness in the shoulder region;
• with pain in the head, tinnitus of unknown origin;
• with a regular crunch of the cervical vertebrae, which brings a person quite strong discomfort;
• when limiting the movements of the neck;
• with weakness and numbness of the hands;
• with regular migraine attacks, dizziness, periodic deterioration of vision, with constant drowsiness and apathy, impaired concentration;
• with injuries, falls, other injuries of the upper segment of the spinal column.

The need for an X-ray of the cervical spine is assessed by the doctor in each specific situation. In most cases, this diagnostic method allows a medical specialist to quickly and accurately determine the diagnosis and begin adequate treatment. 

Preparation

X-ray of the cervical spine is a relatively simple diagnostic procedure that does not require special preparatory measures on the part of the patient. You do not need to adhere to any special diet, take certain medications or starve: just come to the X-ray room, take off your clothes covering the area under study, as well as any metal objects (chain, jewelry, earrings, removable dentures). If an X-ray of the cervical spine is performed as planned, then the patient should think in advance about preparation, put on clothes that are easy to take off, and leave all metal objects and jewelry at home. What is it for? The structure of the metal is not capable of transmitting X-rays through itself; therefore, objects made of this material will be "photographed" in the picture, which may interfere with adequate examination of the image. [2]

Technique of the x-ray of the neck

Cervical X-rays are often performed while the patient is sitting or standing. In this case, the unexplored parts of the body must be covered with a special lead plate or apron (which is especially important if the diagnosis is carried out for young children or a pregnant woman).

The specialist radiologist who performs the procedure leaves the radiological room immediately at the time of image capture. If, for any reason, his presence is necessary, then he must wear appropriate lead protection.

During the fixation of the image, the patient must follow the instructions of the radiologist and remain completely immobile. You can move only if the doctor asks about it - for example, in some situations there is a need to change your posture, bend over, inhale, etc.

Sometimes the doctor insists on taking pictures in different projections, which may require a second diagnosis.

• X-ray of the cervical spine in two projections - anterior and lateral - is a fairly frequent procedure that allows the doctor to take a closer look at the area under study. To obtain a "side" image, the patient has to lie down on his side - for example, on a couch. And to get the "front" picture, you need to lie on your back.
• The vertebral column in some places is particularly mobile, therefore, an x-ray of the cervical spine with functional tests is often performed. Such tests imply the need for tilting or turning the head at a certain angle; sometimes the doctor asks the patient to bend, lie down, or even open their mouth. The doctor's task in this case is to select the correct slope of the X-ray tube. The patient's task is to carefully visit the doctor and follow his instructions.
• X-rays of the cervical vertebrae are sometimes combined with X-rays of other vertebral regions such as the thoracic region. In this situation, they talk about the third X-ray projection.
• X-rays of 1 cervical vertebra are usually performed through the patient's open mouth. The patient lies on his back, stretches his arms along the body. The median sagittal plane of the head is placed perpendicular to the plane of the couch. The patient's head is tilted back so that the plane between the lower edge of the maxillary incisors and the lower edge of the occipital bone is perpendicular to the plane of the couch. The patient opens his mouth as much as possible, and the center stream of rays is directed vertically to the lower edge of the maxillary incisors. [3]
• X-ray of the cervical-collar zone involves taking pictures of the back of the neck up to the level of the IV thoracic vertebra, as well as the surface of the chest up to the II rib.
• An X-ray of the child's cervical spine is performed only if there are compelling indications - for example, for pain in the head of unknown origin, for numbness of the hands, curvature of the spinal column, for causeless pain in the hands, as well as for suspected tumors, pathological disc changes, signs of hernias and local inflammatory processes...
• X-ray of a cervical hernia allows excellent visualization of the problem without resorting to the more expensive MRI procedure. The hernia is accompanied by a displacement of the nucleus pulposus with rupture of the annulus fibrosus: as a result, the nerve roots are compressed - a kind of spinal branches. The oxygen and nutritional supply of the nerve roots is disrupted, the nerve-impulse conduction worsens. [4], [5]
• X-ray for osteochondrosis of the cervical spine allows you to determine the level of decrease in the height of the intervertebral discs, the boundaries of localization of dystrophic and degenerative changes in the spine, to fix the marginal growths. These disorders can be observed mainly in elderly patients. Osteochondrosis causes the appearance of aching and recurrent pains in the neck and / or head: if such pains are severe or persistent, then additional diagnostic methods should be used in the form of computed or magnetic resonance imaging. [6]
• X-rays for subluxation of the cervical vertebra are performed using a lateral projection. The picture is taken in such a way that not only the cervical vertebrae are visible, but also the lower part of the occipital bone, as well as the hard palate. The doctor determines the ratio of the upper cervical vertebrae and the size of the spinal canal using certain radiometric calculations.  [7]
• X-ray with instability of the cervical spine allows you to fix the displacement of the vertebrae. In fact, instability manifests itself in pathological mobility in the segment of the spinal column - for example, in an increase in the amplitude of adequate movements, or in the appearance of atypical new degrees of free mobility. Previously, it was not possible to see such a violation on the X-ray image, but now experts have noticed that the problem is indicated by a visible displacement of the vertebrae with excessive mobility of the vertebral segments. [8], [9]
• An x-ray for cervical lordosis helps to consider the problem: an arcuate bend facing the bulge forward. As a rule, this study is carried out for posture disorders, pain in the cervical spine, numbness in the hands and regular headaches. Pathological cervical lordosis can occur as a result of birth trauma, diseases of the spinal column or the whole organism (for example, this happens with metabolic disorders, the development of tumor processes, etc.). [10]
• X-ray with displacement of the cervical vertebrae is as follows. The norm during flexion consists in the displacement of all vertebrae of the cervical spine relative to each other: in this case, its value is equal and does not go beyond 3 mm. When this norm is exceeded, both in all vertebrae and in 1-2, against the background of the absence of symptoms of physiological mobility of the remaining vertebrae, one speaks of pathological instability of the cervical spine.
• X-ray for uncovertebral arthrosis of the cervical spine allows you to see the destruction or deformation of the intervertebral discs and facet joints of the spine. The most often painful process occurs between the I and II cervical vertebrae. It is impossible to diagnose uncovertebral arthrosis without the use of an X-ray of the cervical spine or MRI. [11]

Contraindications to the procedure

There are a number of contraindications in which the doctor will not refer the patient to an x-ray of the cervical spine, choosing another, alternative diagnostic procedure. For example, X-rays are not performed:

• if the patient is in a serious and unconscious state;
• women during pregnancy (at the discretion of the doctor);
• if the patient has an open pneumothorax.
• Contraindicated X-ray with contrast:
• with increased sensitivity to the composition of the contrast agent;
• with pathologies of the thyroid gland;
• with an active form of tuberculosis;
• with decompensated conditions of liver and kidney diseases;
• with decompensated diabetes mellitus.

The gestation period is considered a relative contraindication, and the doctor must take all necessary precautions when referring a woman for an X-ray of the cervical spine during pregnancy. However, before the doctor always assesses the possible danger of the procedure: it is especially undesirable to do an x-ray in the first trimester and in the last trimester. If you can wait with diagnosis and treatment until the baby is born, then you need to do so without putting the woman and the fetus at unnecessary risk. [12], [13]

Normal performance

How does X-ray work? Its rays, when passing through the tissues of the body, form an image that is transmitted to the screen or reflected in the image. Fabrics that are good at transmitting rays will appear dark in the image, while hard fabrics that absorb rays will be light.

If the study was carried out correctly, without errors, then the doctor will be able to decipher and describe the image without any problems. The description includes an assessment of the condition of the vertebrae (their height and location) and vertebral bends, the distance between the vertebrae, the analysis of darkened areas (the presence of violations of the integrity of the bone, structural changes - fractures, deformities, osteoporosis), the analysis of light areas (the presence of neoplasms or metastases, inflammatory foci). [14]

Based on the data obtained, the doctor will be able to diagnose and proceed with the appropriate treatment. Additional diagnostics will be assigned if necessary.

Cervical ribs on x-ray

Cervical ribs are a congenital defect, predominantly bilateral. More often it happens that the cervical ribs are retracted from the seventh cervical vertebra, less often from the sixth, fifth or fourth vertebra. Sometimes the ribs reach the sternum and are connected to it with the help of a cartilaginous joint, or end with a free end, not reaching the sternum by about 5.5 cm.If the cervical ribs are incomplete (not exceeding 7 cm), then their ends are in contact with the subclavian artery and the nerve plexus of the shoulder. [15]

Often, the owners of such an anomaly are unaware of its existence until the X-ray of the cervical spine. However, rudiments can significantly and negatively affect human health: numbness, hyperesthesia, neuralgia, and digital contracture are observed in the hands. With aggravation of neurovascular disorders, ischemic hand contracture may develop, up to gangrene of the limb. To avoid complications, it is very important to conduct an X-ray of the cervical spine earlier, followed by surgical intervention. [16], [17]

Complications after the procedure

The X-ray method is based on the action of ionizing radiation, which, to a certain extent, poses a risk to the patient, since it can initiate the development of oncological pathologies. It is for this reason that in medicine there is the ALARA principle, according to which the degree of influence of ionizing rays should be reduced to a reasonable minimum volume. This means that the physician must always weigh and evaluate the potential harm from doing the test, as well as the dangers that can occur if the x-ray is not used.

The peculiarity of X-rays is their excellent penetrating ability and the ability to affect the entire area of interest. Experts explain the potential harm of the procedure by damage to the DNA of dividing cellular structures. As a result, mutations appear, which increases the risk of tumor formation. [18]

However, you need to understand that radiation exposure is always measured and taken into account. For example, one X-ray image of the cervical spine has a radiation exposure not exceeding 1 mSv (millisievert). This means that such a procedure can increase the risk of cancer in a person by about 0.0000055%. According to experts, the degree of this risk is much lower than the risk of getting into an accident while traveling in a taxi or public transport.

Most doctors insist that one should not be afraid of radiation during an X-ray, since the risk of negative consequences is negligible, but the risk of misdiagnosis or prescribing the wrong treatment is really high.

In addition, it is incorrect to correlate each episodic detection of a malignant tumor with the fact that a person underwent an x-ray of the cervical spine, or another area.

In some cases, an X-ray of the cervical spine must be performed using a special contrast agent - for better visualization and a clearer definition of the vasculature and tissue boundaries. Contrasting is carried out intravenously: as a rule, specific iodine-containing preparations are injected. But in some patients, after such an introduction, complications may develop:

• rashes on the skin;
• headaches, dizziness;
• difficulty breathing;
• swelling.

To avoid them, even before the introduction of the contrast component, they are checked for the absence of allergies in a person. According to medical statistics, such complications are recorded in less than 1% of cases. [19], [20]

Care after the procedure

The patient does not need any special care after the cervical X-ray procedure. If you wish, you can carry out a little prophylaxis - in order to remove the minimum dose of radiation that has entered the body.

The simplest and most common preventive method is drinking a cup of milk, which does an excellent job of binding and accelerating the elimination of radionuclides. Adult patients can drink a glass of quality dry grape wine, which will also neutralize the effects of radiation.

An optimal replacement for dry wine is natural grape juice with pulp, or just a good large bunch of grapes, or another natural juice of its own extraction. Packaged juices that are sold in stores are not suitable for such purposes, and may even worsen the condition. [21]

From food products to the diet, it is advisable to add those that contain iodine in their composition. For example, seafood, sea fish, greens, persimmon, etc. Are perfect.

If the x-ray of the cervical spine was carried out repeatedly in a relatively short period of time, then these products must be tightly introduced into the diet. In addition, it is important to regularly consume fermented milk products and vegetables.

For frequent X-ray examinations, the following products are especially recommended:

• unrefined vegetable oils;
• natural juices, decoctions and compotes from dried fruits and berries, herbal infusions;
• honey, propolis;
• rice, oatmeal;
• vegetables, herbs;
• quail eggs raw.

It is important to drink plenty of fluids during the day after the procedure, which helps to cleanse the body faster.

Reviews

According to numerous reviews, an x-ray of the cervical spine, made using high-quality equipment, is a fairly informative diagnostic method. It is even better if the X-ray apparatus is digital: this will allow a high-quality study with the lowest possible radiation dose. As experts explain, digital X-ray devices give several times less radiation load on the body, in contrast to devices of the "old" type.

In addition to X-rays, the examination of the cervical spine can be carried out using magnetic resonance imaging. There is no exact answer to the question of what is better than an MRI or an X-ray of the cervical spine. For example, in traumatic injuries, a simple, affordable and fast X-ray examination is often sufficient. And MRI is prescribed in more complex or unclear cases, either when the patient is pregnant, or when it is impossible to conduct an X-ray examination for any reason. The decision to replace the X-ray with a more expensive MRI procedure is made by the attending physician.