X-rays of the lumbosacral spine: preparation, how to do?
According to who, 90% of people at least once experienced the pain in the lower back. This symptom is most commonly seen in patients older than 60 years (up to 50% of cases). Causes painful sensations in the back diverse. In addition to pathology of abdominal organs these include diseases of the vertebrae, intervertebral discs, ligaments and muscles, spinal cord and spinal nerves. A simple method to help diagnose diseases and injuries of the spine, is an x-ray of the lower back.
In this study, well-visualized vertebrae, however, about the status of other structures (intervertebral disks, ligaments) can be judged only by circumstantial evidence. Magadane education invisible on x-ray. However, in cases of ossification or calcification of calcium that is x-rays of the lumbar spine is able to show the diseased discs and ligaments. When injected beneath the arachnoid contrast agents (myelography), you receive the opportunity to study the spinal cord, to assess the patency of the subarachnoid space.
X-rays to diagnose injuries, tumors, degenerative, inflammatory and infectious diseases of the spine. However, the study of discs, ligaments, muscles, spinal cord requires the involvement of other more informative methods. Fluoroscopy can not show education, visible when performing CT or MRI. However, x-rays as most affordable method, widely used in the diagnosis of pathology of the lumbosacral spine. In the framework of MLA research is based on the appoint a doctor for free. Additional diagnostic procedures are usually performed by the patient, and therefore is not available to all categories of the population.
Contraindications to the study
X-rays of the lumbar spine is highly undesirable during pregnancy. Unlike pictures of other areas of the body, in this case to shield the embryo from radiation is not always possible. This is especially true of research sacrococcygeal Department.
X-rays in the third trimester is less dangerous to the fetus. However, useful information on this term gives only a side view. The picture shows a direct projection of the skeleton is superimposed on the spine of the mother, greatly complicating diagnosis. Therefore, pregnant women do not normally do x-rays of the lumbosacral. In case of emergency (suspected trauma or tumor) it is possible to resort to study, not accompanied by irradiation – MRI.
Radiography of the lower sections of the spinal cord is associated with high risk of exposure of sexual organs, the study, therefore, extremely dangerous for pregnant women. The lumbosacral best done in the first 10-14 days after menstruation. This precaution eliminates accidental irradiation of the embryo if the patient does not know about her pregnancy.
In preparation for the examination
The lower part of the spine adjacent to distal intestine. Flatulence in the body is much more difficult to diagnose. For this reason, proper preparation of the x-rays of the lumbosacral spine is extremely important to acquire a high quality photo:
- 2-3 days before the procedure, you must refrain from using amplifying gas products: beans, beans, cabbage, black bread, apples.
- Research should be carried out on an empty stomach. The last meal on the eve before the x-rays must be no later than 18:00.
- Enema is performed in the evening and morning before the test.
X-rays of the lumbar spine involves some additional conditions, improve the informativeness of the picture. Training also includes the emptying of the bladder before the procedure and the removal region of the body exposed to the study of metal objects. Delay last x-rays in the picture and form more shade.
Informative x-ray examination of the lumbar region is highly dependent on the quality of training. Not every patient knows about it. So the doctor who referred the patient for examination, must explain how to prepare for the x-rays of the lumbar spine.
The technique of the research
When performing radiography of the lumbar apply the following projection:
- Video (front and rear).
- Oblique (left and right, back and front).
The can be done in lying and standing position. Vertical position is usually applied for the diagnosis of spinal curvature. To study the mobility of the lumbar, detecting displacement of the vertebrae are assigned to the functional tests:
- Images in the lateral projection is made in flexion and extension in the lumbar.
- In direct projection, you can evaluate the mobility of the spine when bending to the side – left and right.
How do x-ray in the supine position? For better visualization of the spinal structures it is important to know some of the styling features of the patient:
- In the supine position for the study of the lumbar patient’s legs should be bent at the knees. The physiological curvature of the spine (lordosis) is rectified, and the spine is located close to the cassette and parallel to it, increasing the quality and information content of the image. In the study of the sacrum and coccyx this condition is not mandatory, in this case the runs with the extended feet.
- In a lateral projection parallel to achieve the magazine at the spine, the waist area of the patient is enclosed by the radiolucent pillow.
Great attention is paid to the protection of the genitals from the radiation. When you take the picture of a lumbar Department should apply the special plate, impervious to x-rays. However, their use is not always possible. If the screen shuts of physician interest region (for example, when the picture was taken sacrococcygeal Department), he will have to give, otherwise the meaning of the study is lost.
Radiation exposure during radiography of the lumbar vertebrae is 0.7 and 0.08 mSv when the picture was taken by film and a digital camera respectively.
Decoding of the result
Which shows an x-ray of the lumbosacral:
- Anomalies of development: additional vertebrae, changing the shape of their bodies and processes.
- Injury. On the x-ray visible fracture lines, displacement of fragments. In compression fracture of the vertebra becomes wedge-shaped, its height decreases.
- Low back pain. Characterized by reducing the height of the intervertebral gap, destruction of the endplates, the emergence of regional bone excrescences. Another sign is instability of the affected disk, which shows an x-ray with functional tests. When motion is determined greater (Hyper) or less (hypomobility) the convergence of the vertebrae damaged segment than that observed in adjacent healthy areas of the spine. Instability occurs when the displacement of the vertebrae anteriorly, posteriorly or in the direction of more than 2 mm.
- Spondylosis deformans. Pathology occurs due to ossification in the anterior longitudinal ligament. X-ray image shows the coracoid bone growth extending from the anterior and lateral surfaces of the vertebral bodies. The structure of the vertebrae themselves, and also the height of the intervertebral gap is not disturbed. In the case of spondylosis anterior longitudinal ligament changed to 2-3 vertebrae. Lose it over a larger area is called Forestier disease (fixing ligaments).
- Arthrosis of the intervertebral joints (spondylosis). Radiologically evident narrowing of the joint space, the appearance of bony growths of sclerotic changes in the structures involved in the formation of the joint.
- The herniated disc. On the x-ray to determine this pathology is extremely difficult. Symptoms of hernia – straightening of the lordosis, scoliosis (abnormal curvature), wedge-shaped form of the intervertebral slit (symptom of «struts») – are not always visible. The method of choice to diagnose pathology of the disc is an MRI.
- Tuberculous spondylitis. The intervertebral gap in the area of the narrows is marked local osteoporosis in the vertebral body, cavity and edge of destruction. Possible wedge-shaped deformation of the vertebrae.
- The tumor on the x-ray visible if you grow to large size and destroying the structure of the vertebral column. Small tumors may not be detected by radiography.
X-ray allows to visualize the pathology of the vertebrae. However, diseases of other entities, ligaments, discs, nerve roots, the spinal cord – to detect in the picture is extremely difficult. Therefore for specification of the diagnosis it is necessary to resort to more informative methods – CT and MRI.
Other methods of diagnosis of diseases of the spine
X-rays with contrast (myelography or pneumonologia) allows you to explore the unseen on a conventional picture structure of the spinal canal. However, with the introduction of such a diagnostic procedure, like an MRI, to use the contrast is not necessary. Magnetic resonance imaging – a method is shown for research of spinal cord and subarachnoid space. MRI is well established in the diagnosis of intramedullary tumors, herniated discs, traumatic injuries of the spinal cord.
CT is superior in informative x-ray. This study helps to assess the state of not only vertebrae, but also other structures: ligaments, muscles, disks. However, to visualize vessels, or tumors of the spinal cord, as the x-rays, sometimes requires the introduction of contrast, which is accompanied by the risk of side effects. The disadvantage of this method is the radiation exposure of 5.4 mSv per procedure, making it impossible to study pregnant.
Another radiological method used in the diagnosis of pathology of the lumbar vertebrae, is a radionuclide study. In the body of the patient is administered a radiopharmaceutical is a substance containing the radionuclide. The radiation emitted by the last recorded diagnostic instruments allowing to assess the accumulation of the drug in the structures of the spine. The method is used to detect tumors, primary and metastatic tumors, and to diagnose inflammatory diseases of the spine.