Posts tagged ‘lumbar’

May 23, 2014

Case of Note: Herniated Disc

herniated lumbarAs we worked through spinal conditions and imaging this week, we found a useful and not entirely uncommon case study: A patient with low back pain.

 

This patient presented with severe lower back pain and pain extending into both lower legs.

 

This imaging was done using MRI technology. He was prescribed the procedure due to the severity of pain in his lower legs, a symptom called radiculopathy, which is a shooting pain distributed through the nerves in the legs. You can see a disc has protruded from the normal position between the lumbar vertebrae and presses on the spinal canal (between numbers 3 and 4 the black gap between vertebrae seems to “spill” out in the back). This MRI exam was extremely useful in identifying the level of patients abnormality and and the extent of abnormality.

 

Initially, the patient elected a conservative route for treatment and had an epidural pain injection. Pain medicine is injected to the area around the herniated disc for relief of pain. This procedure resulted in temporary partial pain relief. After that treatment and a course of physical therapy he was referred for a surgical consultation as his pain continued. A microdiscectomy gave relief and has allowed him to return to normal activity.

Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

May 14, 2014

What’s Up with Your Neck? (and just below…)

Image

Have pain in your neck or upper back? You are not alone! While less common than low back pain, pain in the neck is a common complaint leading to doctor’s office visits. Pain in the upper back is somewhat less common, but we will include it in our discussion for completeness.

 

In a recent post we talked about imaging of the lumbar spine, the lower portion of the spine which sits behind your belly.  Much of the imaging for the rest of the spine is similar to what is done for the lumbar region.

 

The cervical spine (coming from the Latin word for neck) is sometimes referred to as the C spine. It consists of the first seven vertebrae (from the skull) and the cartilage discs between them, in addition to adjacent ligaments and muscles. A lot of motion (up,down, around!) occurs in this part of the spine during the day, so this is a common spot for symptoms of overuse or muscle strain to occur.

 

Patients with cervical spine problems may have pain in the neck with or without symptoms in the upper arms/shoulders – this can be pain or can be nerve type symptoms like numbness or tingling. How far the symptoms go down your arm can help indicate the level of involvement in the cervical spine.

 

The T Spine is the thoracic spine consisting of the 12 vertebral bodies, discs, adjacent muscles and ligaments at chest level. There is less movement of the spine at this level, so symptoms here are less common. Symptoms of thoracic spine problems may include pain in the upper back, shoulders, arms, or to the sides of the chest. Nerve symptoms like numbness, tingling or weakness may also be present.

 

As in the lumbar spine, there are a lot of age-related changes involving the discs and/or the adjacent bones; these may or may not be related to the patient’s symptoms. Imaging of the cervical and thoracic spine is generally performed after careful history and physical examination, and may be delayed to see if a trial of conservative treatment improves symptoms. Imaging immediately may be warranted if there are serious symptoms such as major trauma, weight loss, or nerve symptoms, particularly weakness of the arms or legs.

The spectrum of problems in the cervical and thoracic spine is similar to that in the lumbar spine and can include disc displacement, fractures, and muscle strain. Less common causes of neck and upper back symptoms include disease in the spinal cord itself, spinal cord tumors and things like multiple sclerosis. Note that the spinal cord ends at approximately the upper lumbar level; therefore, these problems do not directly affect the lumbar spine.

 

Imaging of the cervical and thoracic spine is similar to that for the lumbar spine. X-ray, CT and MRI can all be used to diagnose problems.Plain films or x-rays may be the best starting point as they can show alignment and fractures. X-rays can also show any narrowing in the spaces between the vertebra indicating disc disease. A CT shows bones and adjacent tissues and is the test of choice if we are concerned about fractures. CT can see the cord and nerve roots if we do it after a myelogram (more commonly done with C spine than with the T spine). Last, an MRI can show the spinal cord, nerve roots and discs and how they relate.

 

Ultimately, imaging of the neck and upper spine may be helpful to determine the proper course of action to get you on the road to your best possible health!

(Image credit: Illu vertebral column via Wikimedia Commons Copyright Public Domain)


Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

May 8, 2014

Imaging of the Lumbar Spine

Lumbar vertebrae anterior by Anatomography via Wikimedia Commons Copyright Creative Commons  Creative Commons Attribution-Share Alike 2.1 JapanTo continue our conversation about back pain, today we’re going to focus on the different imaging tests that may be requested to evaluate someone with back pain, specifically lower back pain. Imaging for lower back pain will likely focus on the lumbar spine. It’s the lower back region, usually the lower 5 vertebral levels – the series of vertebrae highlighted in the picture here.

 

There are several modalities we use to examine the lumbar spine, including (but not limited to) x-ray, MRI  and CT.

 

Conventional films or X-rays are often the starting point when evaluating someone with back pain. This allows an overall assessment of alignment and can look for signs of a more serious issue requiring additional imaging, like a fracture or an area of abnormal appearing bone. If the back pain follows recent trauma, is seen in someone with known osteoporosis or is in someone over the age of 70, conventional films may be the imaging study of choice and may be the only imaging needed.

 

MRI (magnetic resonance imaging) of the lumbar spine is the most common imaging test for back pain because of its ability to see details of the soft tissues, including the nerves as well as the bones.  As an added benefit, no radiation is involved. Remember with MRI the images are made with a large magnet and radiofrequency pulses (those are the loud sounds you hear). With MRI we can examine all of the following:  the structure of the discs (the cartilage cushions between the vertebrae) and look for how the disc relates to adjacent nerve roots; the bones that make up the spine including the vertebral bodies;  the conus (the lower end of the spinal cord); and the soft tissues surrounding the area. Imaging takes about 30 minutes, and remember – you can’t have an MRI if you have a pacemaker (most types anyway!) or some implanted devices like stimulators. Lastly for the safety of all you cannot bring metal of any kind into the room!

 

CT (computed tomography) is an additional means of looking at the spine. Images with CT are made with x-rays that are created in a ring around the body allowing the body to be imaged in thin slices. CT allows an excellent look at the bones making up the spine. It may be the study of choice for evaluation of acute trauma or fracture. Changes in the discs can be seen, but the nerve roots are not visualized in a routine CT. There are times when a CT of the spine is performed after a myelogram – this is a procedure where contrast material is put in the fluid- containing space surrounding the spinal cord and nerve roots. This then allows CT to better evaluate the nerve roots and soft tissues of the spinal canal. A CT scan may be used to help with planning before back surgery. A CT lumbar spine takes around 10 minutes. It should not be used in those who are pregnant unless it is an emergency (as with severe trauma).

 

All of these are straightforward procedures that can give an excellent anatomic evaluation. Remember imaging of the spine will often reveal age-related changes in the discs and bones, not all of which will be associated with symptoms. Imaging is not always needed for back pain – see your doctor to determine if imaging can help get you on the path to your best possible health!

(Image credit: Lumbar vertebrae anterior by Anatomography via Wikimedia Commons Copyright Creative CommonsAttribution-Share Alike 2.1 Japan)

Diagnostic Imaging Centers blogs on regularly about women’s health atwww.mammographykc.com and general radiology atwww.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!