X-ray of the waist with functional tests: how to prepare and how to do?

The most accessible diagnosis, which allows visualizing the internal structure and assess the state of the skeletal bones of the spine, is radiography. The procedure is painless, does not require complicated preparation, affordable and performed quickly in almost all medical institutions. The x-ray of the lumbar spine is used primarily to detect defects in bone structures (fractures, osteophytes, curvatures, dislocations, shifts, neoplasms and inflammatory processes), as their tissue is most contrasted and clearly visible on the radiograph.

Only this study is sometimes not enough to assess the state of fibro-cartilaginous structures of intervertebral discs and soft tissues. To accurately establish that there are stretchings of muscles and ligaments, damage to nerves and vessels, spinal hernia, additional methods should be used additionally.

Indications for the procedure

Send the patient to the radiography of the lumbar spine can be different specialists: therapist, neurologist, vertebrologist, oncologist, orthopedist. By directing the patient to the diagnostic department, the doctor indicates the vertebral column to be examined and the alleged diagnosis.

The basis for referring a patient to an X-ray may be:

• complaints of numbness and cramps of the muscles of the lower limbs;
• assumptions about possible deformations of the vertebral column in this area: dislocation of discs, hernia, bony growths, compression, causing pain, tingling, numbness in the lumbar region;
• traumatic injuries: fractures, dislocations, subluxations of the lumbar spine;
• oncological diseases of this localization, primary and metastatic;
• collagenoses;
• the alleged infection of the spinal column - osteomyelitis, syphilis, tuberculosis;
• suspected congenital anomalies of the spine;
• pre- and postoperative examination;
• monitoring the results of the therapy.

[1], [2], [3]

Preparation

Before carrying out of the given diagnostic action it is required to spend simple preparation for research. The very procedure of radiographing the lower part of the spine with X-rays is performed in the morning on an empty stomach. Previously, the night before, it is necessary to clean the intestines. This is done so that the gases accumulated in the intestine do not distort the clarity of the image and, accordingly, the result of the study.

It seems that everything is simple and clear, nevertheless, how to cleanse the intestine before carrying out an X-ray study? There are several ways of cleaning.

It is possible to resort to the help of physicians and to do hydrocolonotherapy. The procedure of cleaning the bowels with a water jet will take about twenty minutes, it will cost a certain amount of money and time spent on visiting the medical institution by appointment.

Most patients prefer not to bother and make their own cleansing enema in front of the x-ray at home. Apparatus for this procedure, as a rule, is everyone in the home medicine cabinet - a silicone (rubber) pear or a mug of Esmarch. Through any given device in the intestine of an adult, you need to pour a 1.5-2 liter solution with a temperature of about 37-38 ℃. The simplest and most popular solution is boiled water with salt dissolved in it in proportions: a teaspoon of salt per ½ liter of water, therefore, in 1.5 liters we dissolve three spoons, and in two - four.

You can brew medicine chamomile according to the prescription presented in the instructions on the package. The cleansing enema before the X-ray with this infusion cleans up the gases and sanitizes the intestines.

When the solution is ready and poured into Esmarch's mug, the patient lies on the left side, slightly bends the legs in the knees and inserts a tip, previously oiled with vaseline, into the rectum, squeezes the hose and slowly pours the solution into the intestine. Then you need to try to keep the solution inside for as long as possible. Then - visit the toilet and get rid of the contents of the intestines.

For those who do not tolerate the cleaning procedure with an enema, you can use other methods: drink a few (5-7) glasses of salted water at night or use a special drug. Fortrans is a laxative intended for cleaning the intestine before operations and diagnostic procedures. The drug is diluted with water in the proportions of one packet per liter, and the amount of water is calculated from a ratio of 1 liter per 15-20 kg of body weight. They drink the laxative solution slowly. The rate of absorption of the solution should be approximately liter per hour. The entire portion of the solution can be drunk at night in one sitting, or divided into two portions.

There are different options. They are clearly described in the instructions to the laxative. The patient chooses the most acceptable option for himself, depending on the time of the procedure and his own possibilities of absorbing a large amount of fluid. Fortrans is an effective and safe enough drug, but, like all medicines, there are contraindications to its use. This sensitization, damage to the intestinal mucosa for various reasons - inflammation, tumors, polyposis, the risk of obstruction, incidentally, the enema is also undesirable in these cases. If you are taking medications, you should familiarize yourself with the specifics of the interactions in the instructions to Fortrans.

It should also be noted that enemas are not put and the laxative is not taken immediately after a meal. It is necessary that the last meal take at least three hours, and this will be your last meal before the procedure. Clean, not soda water in the evening you can drink, if you want, but not liters, but a few sips.

The diet before the x-ray of the lumbar spine also matters. Approximately two to three days before the proposed diagnostic measure should not eat heavily digested food and food that promotes gas generation. They include fresh muffins, biscuits and other sweets, carbonated drinks, coffee and alcohol, fresh milk, bread, beans, cabbage in any form, smoked meat and fish, sausages, raw vegetables and fruits.

Many people have a question that you can eat before the X-ray of the lumbar region. Relax, the diet is not tough. If you eat a piece of bread (and not half a loaf of bread) with a stew or soup dish, then the clean-up exercise all this will make it less. The same applies to a glass of milk, and a sandwich with sausage. Nevertheless, if it is possible to choose, then preference should be given to easily digested food: soups, vegetable purees, meat broths. It is possible with meat or fish, but boiled or baked. From drinks it is better to give preference to tea and simple clean water. Of course, without soda, alcohol, coffee and pea soup, you can do three or four days. Cabbage also causes increased gas production in many people. In general, everyone knows their reaction to products and can assume the result. If there are problems with the digestion of food during the preparation period, you can take an enzyme preparation (mezim, festal), which promotes digestion, before eating. With meteorism, which appeared at the wrong time, you can also cope with activated charcoal or enterosgel.

On the day before the X-ray, it is recommended that you last eat no later than six hours, so that the peak of cleaning activities does not occur on a night.

In addition, wearing underwear in the morning before the procedure, pay attention to the fact that it was not decorated - metal spraying, rhinestones.

[4], [5], [6]

Technique of the x-ray of the lumbar spine

On the day of examination it is forbidden to eat, drink, smoke. In the X-ray room before taking the place indicated by the doctor and accepting the necessary position, in addition to the outer clothing (which will be removed before the laundry), the patient must remove all metal products from his body.

X-ray of the lumbar spine is performed in most cases when the patient occupies a supine position (a straight posterior projection) or on the side (lateral), sometimes, depending on the capabilities of the equipment, sitting or standing. If necessary, additional information can be assigned to the spine in an oblique projection.

The patient lies on the table and takes the necessary position, adjacent to the subject areas of the body (neck and chest) covered with a lead vest to protect the organs located there from radiation. During the imaging, the patient should not move or even breathe, carefully following the requirements of the radiologist. The procedure itself takes a couple of minutes, the pictures are usually ready in a quarter of an hour.

Based on the diagnostic version of the images already received, and also - taking into account the patient's complaints, radiography of the lumbar spine with functional tests can be prescribed. The purpose of this study is to assess the mobility of this department. The picture is taken at the maximum positions of the bent and straightened spine. The images taken in standing or sitting position are considered preferable and most informative, but the lying position can be used, taking into account the type of equipment, survey tasks and the patient's health condition.

The functional X-ray of the lumbar spine is made in the lateral projection.

1. The patient is standing, touching sideways to the vertical X-ray stand. First, he leans forward as much as possible, trying to touch the floor with his knees straight - in this position the first picture is taken. Then, unbending, bends back as much as possible, hands at the same time raise up, clasping his hands in the lock on the back of the head - the position of the second picture.
2. The patient sits, clinging to the side of the body to the bar, tilting forward, arms clasped around his knees, and his elbows resting on the hips (the first picture). From the same position sitting for the second picture, the patient bends back as much as possible, with his head thrown back and bent in the sternum.
3. A snapshot in the pose of bending is done lying on the side in the embryo pose, while the head is laid on a bent arm. The second picture (maximum extension) is done standing at the counter, just with one hand the patient adheres to the edge of the table.

Contraindications to the procedure

Radiography is not performed in patients with metal or electronic implants.

Patients with mental illnesses that make it impossible to perform the procedure, because of a lack of understanding of the need to comply with certain requirements (take the right posture, hold your breath) do not plan radiographs.

Pregnancy and children under 15 are absolute contraindications to routine radiography due to the dangers of undesirable effects on the fetal development of the unborn child and the growth of bones in childhood. The only exceptions are cases when this diagnosis can save the life of this category of the population - acute injuries and the need for urgent surgical intervention. Emergency radiography for vital signs is carried out practically to all categories of the population, observing precautions.

Temporarily X-ray may be contraindicated if the patient is unable to stay still even for a short time, cancel the procedure because of inadvisability may be due to lack of preparation of the intestine.

People with reduced immunity can be deferred to a scheduled diagnosis until a more favorable period.

In people who are overweight, this study may not be sufficiently informative, since the layers of subcutaneous fat lead to insufficient clarity of X-rays.

[7], [8], [9]

Normal performance

X-ray images show changes in the structure of the bone tissue of the vertebrae (fracture, fracture, wear, thinning and deformation of bones and cartilaginous tissue), various pathologies of the spinal column (curvature, constriction, displacement of the vertebrae, cysts, inflammatory processes), suggest the presence of neoplasms, hernias and deformations of shock-absorbing disks between vertebrae.

According to radiography, it is possible to diagnose lumbosacral osteochondrosis, osteoporosis, radiculitis, spondylolisthesis, fracture, disc rupture, bone spurs and other outgrowths. Occasionally, as occasional findings, pathological processes that are not related to diseases of the spine are diagnosed.

Individually, after taking pictures in the necessary projections and having certain complaints, the doctor may prescribe additional studies. X-ray of the lumbar spine with functional tests allows to estimate the total volume of movements in this area. This study is necessary when the patient has a partial or complete restriction of the motility of body parts associated with the pathology of this localization.

[10], [11], [12]

Description of the X-ray of the lumbar region

In the image corresponding to the norm, the visible part of the lower part of the spine should be smooth, without curvatures, the number of vertebrae, their shape and size should also correspond to the necessary parameters, the integrity of the bone tissue structures should not be disturbed, surrounding the spine with soft tissues without swelling.

X-ray reveals the signs of major diseases of the spine or forces to assume trouble and indicates the localization of the pathological process.

The image is made in black and white color scheme with areas of different intensity. Bones are the lightest, almost white, clear structures, and soft tissues are seen very poorly, since X-rays pass through them almost completely. In the picture, fractures are clearly visible - they look like dark irregular cracks (cracks) crossing the bone, at the fracture sites there may be displacements - mismatches of the lines of the lateral edges of the bone. Scoliosis is visualized in the image as an asymmetric arrangement of the spinal column (deviation to either side).

Lumbar osteochondrosis is diagnosed by such signs as a decrease in the lumen clearance between the vertebrae, in which the intervertebral disc is located. Because of the uprightness in a person, the load on the lower parts of the spine is the highest, they are forced to depreciate it constantly when running, jumping, walking. It is at the level of the lumbar region that pathological changes are detected in the first place.

The presence of osteochondrosis is also indicated by the presence of compensatory degenerative changes in the form of osteophytes (marginal outgrowths on the body of the vertebra), formed in the places of permanent (chronic) damage to the ligaments of the spine.

Complication of osteochondrosis spondylosis is visualized in the image as beak-like growths that connect vertebrae located in the neighborhood.

There is also a noticeable decrease in the density of the bone tissue of the vertebrae, in places of reduced density the film is highlighted more strongly, and these areas become darker (gray instead of white).

The stages of the disease can also be determined from the x-ray image: the first corresponds to a decrease in the intervertebral fissure to a height not exceeding one-third the height of the vertebra; the second - up to half. The third degree corresponds to the remaining size of the intervertebral fissure, which makes up no more than a third of the height of the vertebral body.

On X-ray, you can see the lumbarization of the first sacral vertebra (S1). This pathology appears as an additional fragment of the spine, separated from the main axis by enlightenment. Congenital defect, usually detected by chance on the X-ray. It is one of the causes of lumbago, scoliosis and early osteochondrosis. In this case, the first sacral vertebra is separated from the sacrum partially or completely, becoming the sixth lumbar (in the norm there are five).

The sacralization of the fifth lumbar vertebra (L5) shows that the lumbar vertebrae are not enough. There are four instead of the prescribed five and there are no facet joints, which also leads to early osteochondrosis, caused by an increased load on the remaining due to the lack of a vertebra.

Hernia of the lumbar spine is determined by the presence of some indirect signs. Its existence, rather, can be suspected, than accurately determined. With a hernia, soft tissues are affected, so it is not visible on the roentgenogram. Analyze and compare the frontal and lateral shots. Assume that a hernia can take place if the vertebrae look like high-intensity large formations of a rectangular shape, with slightly concave sides and rounded corners. The lateral projection shows the presence of osteophytes. Experienced radiologists analyze the contours of the vertebrae, the distance between them, the intensity of the passage of rays through the bone tissue, but the error is still possible - such signs may indicate dislocations and fractures, neoplasms, scoliosis and kyphosis.

Sometimes on the x-ray you can see blackouts with sharp round contours, indicating the possible presence of tumors (not necessarily the spine, others can also be projected in this zone). Sites darker with blurred fuzzy boundaries can be interpreted as swelling of inflamed tissues. Nevertheless, no doctor will tell exactly what the dimming means on the x-ray in the lumbar region. More research is needed.

[13], [14], [15]

Complications after the procedure

In medicine, for the purpose of diagnosis, low-intensity X-ray irradiation is used, which lasts for a short time. Even with repeated repeated carrying out of this diagnostic measure, no immediate consequences after the procedure can arise. And remote, for example, risks of development of oncopathology in the future in people who have undergone this examination, and have never been practically the same.

High-energy electromagnetic waves used in equipment for carrying out radiography are not able to accumulate in the tissues of the body, like radioactive chemical elements, and therefore, no radiation-removal measures are required after X-ray examination.

Nevertheless, an X-ray examination should be performed only at the doctor's prescription and follow the dose of radiation received during a lifetime. Diagnostic examination is carried out without penetration into the body, painless and withdrawal after the procedure is not required. In our case, the dose of radiation on conventional equipment is 0.7 mSv, on the digital one - 0.08 mSv received for the procedure (for comparison: the permissible annual dose for doctors-radiologists should not exceed 20-50 mSv).

The main complication after the procedure is the exceeding of the permissible radiation threshold, and to exceed it even on old equipment, it is necessary to make an x-ray of the lumbar spine more than twenty times a year.

So, we found out that complications after the procedure of radiography do not arise. But refusal of diagnostics can lead to serious consequences, it is possible to "look through" fractures, dislocations, neoplasms, degenerative changes. Inadequate treatment leads to complications of diseases, constant pain and discomfort, loss of the opportunity to walk independently.

Feedback about the procedure is most favorable, it is short-lived, does not cause any unpleasant sensations and the patient's condition before and after the procedure does not change. The main impressions and questions concern the preparation for the X-ray, in particular, the cleaning of the intestine. Very good feedback on Fortran. Patients with experience who have something to compare, it is recommended not to do an enema, but to cleanse the intestines with this remedy.

Thanks to the cheapness of radiography, the availability of radiological laboratories in almost all out-patient departments, as well as high information content, it is very common. Another advice that "experienced" patients give: if possible, do X-rays in offices equipped with the most modern equipment. It has many advantages - from the comfort of the patient himself and a better image to the lowest radiation doses.

[16], [17], [18]

Analogues to an X-ray

An alternative radiation method of diagnosis is computed tomography (CT). Unlike an x-ray, the doctor receives a clearer three-dimensional image, which can be copied to a laser disc or USB flash drive, sent by e-mail. Computer tomography can be done for patients with implants. However, this kind of research gives the most significant radiation load. The dose of irradiation with computed tomography of the lumbar spine is 5.4 mSv.

Magnetic resonance imaging (MRI) is quite informative, considered safe. It can also be used to diagnose injuries and diseases of the spine. However, in addition to the high cost of the study, ray methods (X-rays and computed tomography) are considered more informative in the study of bone structures of the spine. MRI improves visualization of soft tissues, vessels and nerves, as well as neoplasms in them.

When examining a patient, different methods can be used, the choice depends on the patient's complaints and the preliminary diagnosis, but the x-ray of the lumbar spine is versatile and informative, and, importantly, is available. In some cases, it can give a complete picture. If necessary, it can be supplemented with an MRI.

[19], [20], [21]