Methods of examination of the spine

The desire to fully examine a patient often leads doctors to designate studies that duplicate each other in the nature of the information received. For each individual patient, the scope of the examinations should be determined individually, and it is always desirable to designate those studies that are most informative for solving a particular diagnostic task. Therefore, we found it necessary to provide a description of the survey methods most frequently used in vertebrology, listing the main tasks that can be solved with their help. The description of methods is given not in alphabetical order, but in accordance with the frequency and significance actually used.

Survey radiography (standard spondylography) is the basic method of radial examination and is performed in the prone position in two projections. The survey is performed with the maximum capture of the entire spine, and on the anteroposterior roentgenogram - also the wings of the iliac bones. The method allows:

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

Computed tomography (CT) is the most informative for assessing the bone structure of vertebrae in a limited number of (one or two) vertebral segments, primarily in the posterior parts of the body, arches and processes (transverse, articulate, spinous). It is possible to visualize the state of paravertebral tissues at the level of the zone of interest. In combination with contrast myelography (CT + myelography), the method is used to assess the permeability of cerebrospinal fluidways, the state of the spinal canal and, roughly, the spinal cord in the zone of interest.

Magnetic resonance imaging (MRI) is the most informative for:

• visualization of the spinal cord, its reserve spaces (subarachnoid and epidural), the vertebral canal in general and at the level of the zone of interest (transverse slices);
• visualization of disks;
• early detection of pathology, accompanied by microcirculatory disorders in the spine and not detected by other methods of radiation diagnosis;
• assessment of the condition of paravertebral tissues.

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

X-ray tomography - the implementation of layered X-ray sections allows us to clarify the nature of pathological changes in the vertebrae and paravertebral tissues, to evaluate the structure of the vertebrae.

Spondylourography is a combination of spondylography with simultaneous contrasting of the urinary tract. Usually used for suspected concomitant pathology of the urinary system in children with congenital vertebrae defects. Simultaneous evaluation of the spine and urinary tract can reduce the overall radiation load in the study.

Myelo (tomo) graphy - examination of the spinal canal with the introduction of contrast substances in the subarachnoid space allows:

• visualize the subarachnoid space and determine its patency;
• tentatively visualize the spinal cord;
• to reveal extradural and extramedullary formations, which violate the passability of the cerebrospinal fluidways;

Echospondilography (ESG) - ultrasound examination of the spine and spinal canal. The method is indispensable for prenatal diagnostics of vertebral developmental defects, it is also used for an approximate evaluation of the condition of the spinal canal;

Epidurography is the study of the spine and spinal canal with the introduction of contrast substances in the epidural space.

Venospondilography (WASH) - examination of the spine with contrasting epidural and paravertebral venous tracts. Contrast substance is introduced into the bone structures of the vertebrae (usually - in the spinous process). Assess the state of venous epidural plexuses. The method can be used for the early detection of volume formations of the epidural space.

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

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

Thus, depending on the diagnostic task, the significance of one or another method of study varies significantly:

• to determine the type and magnitude of spinal deformity - the most informative is standard spondylography, spondylourography;
• to evaluate the structure of 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) - echoespondilography;
• for the detection of hemodynamic disorders in the vertebrae - MRI;
• for early detection of solid and systemic tumor lesions of the spine (dorotgenological stage), estimates of their prevalence in vertebral segments and bone system - radioisotope scanning, MRI;
• to assess the epidural and paravertebral venous pool - venospendilography.
• to assess the condition of paravertebral tissues - MRI, CT, Rengenotomography.

[1], [2], [3], [4], [5], [6], [7]