Spine x-ray is an image of various parts of the spinal column obtained as a result of the passage of X-rays through the corresponding area. It is indicated for suspected spinal curvature, herniated intervertebral discs, dislocation of vertebrae, infectious diseases, tumor lesions, spinal column fractures, degenerative processes and other vertebrogenic pathology. The study may cover the entire vertebral column or certain parts of it (cervical, thoracic, lumbosacral, coccyx). It is performed in 2 projections: straight and lateral or oblique. In some cases, functional tests or contrast enhancement are used (during discography, myelography).
Indications for x-ray of the cervical spine are traumatic injuries, external changes indicating the presence of congenital malformations and diseases of the vertebrae, as well as dizziness and headaches that occur with sudden changes in the position of the head. Spine x-ray in the thoracic region is usually prescribed for injuries and pain syndrome. Images of the transitional (thoracolumbar) departments are most often used to diagnose compression fractures, since it is this part of the spine that is most susceptible to such injuries.
The list of indications for spine x-ray in the lumbar region includes injuries, pain, paresthesia and movement disorders in the extremities. The high need for such studies is due to the prevalence of lumbar osteochondrosis and other degenerative-dystrophic processes of the lower vertebral column. X-ray of the sacrum is rarely performed, as a rule – with severe pelvic injuries. X-ray of the coccyx is prescribed if a fracture of the coccyx is suspected. An overview spine x-ray is performed for scoliosis, kyphosis and kyphoscoliosis. To study soft tissue structures, myelography and discography are used (studies using a contrast agent).
There are no absolute contraindications to spine x-ray. Among the relative contraindications are childhood, pregnancy and a large number of similar studies in the anamnesis. Some experts do not recommend X-rays during lactation. It is impractical to prescribe images of the lumbosacral region within a few days after X-ray contrast studies of the abdominal cavity, since barium residues in the intestine can reduce the informative value of radiographs or make them unsuitable for diagnosis at all. In some cases, the excess weight of the patient is considered as a limitation. Spine x-ray is not performed in a state of motor excitement.
The list of contraindications to X-ray contrast studies includes allergies to contrast agents, severe liver and kidney pathology, hypertension, arterial hypotension, heart disease, increased bleeding and increased blood clotting. In all cases, the decision on spine x-ray, its replacement by another diagnostic procedure (CT of the spine or MRI of the spine), as well as the appointment of medications for preliminary correction of the patient’s condition is taken individually.
When examining the cervical and thoracic sections, special training is not required. During 3-4 days before the x-ray of the lower spine, it is recommended to refrain from using gas–forming products, including carbonated drinks, black bread, milk and legumes. On the eve of spine x-ray, especially in the presence of excess weight, it is advised to take a laxative or cleanse the intestines with an enema. All of these measures are aimed at reducing the amount of intestinal gases that degrade the quality of images.
Methodology of conducting
Before X-ray examination of the spine, the patient is asked to take off clothes and metal objects and remain motionless after laying. The choice of styling during spine x-ray is determined by the characteristics of a particular segment. To study the movable cervical region, not only straight and lateral, but also additional projections are used. To identify pathological changes in the upper cervical vertebrae, images are taken through the mouth.
When examining a sedentary thoracic region, spine x-ray is usually prescribed in two projections. The lumbar region is removed in two or more projections (depending on the type of pathology). In most cases, one or two standard projections are sufficient to study the sacrum and coccyx. The duration of spine x-ray ranges from 10 minutes to half an hour (depending on the number of images). At the end of the study, the radiologist examines the images, draws up a conclusion and passes it to the attending physician.
Interpretation of results
The study provides information about the presence of fractures and dislocations, displacement of fragments, the level of compression and other features of traumatic injuries. In addition, spine x-ray makes it possible to assess the magnitude of the physiological bends of the spine and the position of the vertebrae in relation to each other. When studying radiographs, changes in the structure of bone tissue, bone defects and growths are revealed.
Based on the x-ray of the vertebral column, it is possible to conclude about the height of the intervertebral discs, the presence of pathological changes in the joints of the spine, benign and malignant lesions of bone tissue, as well as secondary foci in the vertebral column in oncological processes of other localization. To clarify the data obtained during x-ray, if necessary, other studies (CT, MRI) can be used.