Posts tagged ‘vertebrae’

May 14, 2014

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


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 and general radiology Visit our sites for more helpful information!

May 6, 2014

Oh! The Pain in my Back!

Low back pain by Harrygouvas via Wikimedia Commons Copyright Creative Commons Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0)Lower back pain is common. In fact, in the US it is a leading reason for a trip to see the doctor. There are many causes for back pain – some of them related to the spine and its components and others related to adjacent structures. Things like kidney stones and diverticulitis can present with back pain. There are also times when the source of back pain is never fully found.


When should you see your doctor and when is imaging for back pain appropriate?


The good thing about back pain is that the natural course for most is improvement of symptoms by around 4 weeks – whether you have specific treatment or not. If you have severe back pain, if it is associated with other symptoms like pain or nerve changes in one of your legs (numbness, burning sensation or tingling) or if symptoms are not improving, a visit to the doctor is in order.


There are published guidelines helping your healthcare provider decide if you will benefit from imaging of the spine. A careful history and physical are key.


Why not image everyone with back pain? Imaging the spine in the majority of us will show abnormalities – our discs (those cartilage cushions between the vertebral bodies) will begin to show changes as we get older. This is a natural age-related process related to being upright – the discs are only good for so many miles! The problem with imaging for back pain is we will often see abnormalities of the discs – some can even be large and impressive – but they do not always correlate with your symptoms. Imaging can lead to confusion and over-treatment, and for uncomplicated back pain will likely not affect how your back pain is managed.


When will imaging for back pain help most? Imaging is recommended for immediate evaluation of some patients with back pain with history or signs that might indicate a serious problem requiring immediate intervention. These include patients with history or signs that might make cancer (a RARE cause of back pain) more likely – things like a known cancer elsewhere in the body or significant weight loss. Signs that there might be an infection are important. Any symptoms that suggest there might be involvement of the nerves to the lower body may also warrant immediate imaging.


Imaging after a trial of physical therapy (usually after a 6 week period) may be indicated in patients who fail to show improvement or have worsening of symptoms. Imaging may also be performed if symptoms persist in patients with history of osteoporosis and concern for new fractures.


How do we image and which test do we pick? Those will be explored in our next post on back pain!


So, if you have low back pain remember that in the vast majority of patients, symptoms will get better – although it may take a few weeks. A visit to your doctor will help determine if imaging is needed and will help in the management of your pain.

Image Credit: Low back pain by Harrygouvas via Wikimedia Commons Copyright Creative CommonsAttribution-ShareAlike 3.0 Unported (CC BY-SA 3.0).

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