CT scan of the lumbosacral spine – modern method diagnostics, visualizing the structure of the vertebrae, cartilage, bone tissue, intervertebral discs, ligaments and spinal cord.
The lumbar region consists of 5 vertebrae and they are subjected to considerable weight. Below is the sacrum, which is the base of the spine and has a triangular shape. Together, the departments form the lumbar-motor apparatus, which controls the inclinations and rotations of the human body.
What does it show?
Diagnosis states the following pathologies:
- Tumor (benign and malignant);
- Metastases (number, location);
- Pathology of the intervertebral discs and other tissues of the spine;
- Purulent inflammatory processes;
- Arthritis;
- Destruction or pathology of the structure of the vertebrae;
- Compression of the spinal cord;
- Fractures or injuries in the area being examined;
- Change in the spinal canal;
- Herniated disc;
- Hemorrhage.
Indications
An orthopedist, rheumatologist and neuropathologist are sent for diagnosis with the following indications:
- Injury or injury to the area;
- Hernia;
- Suspicion of the presence of a tumor;
- neoplasm;
- Curvature of the spinal column;
- Pinched nerve endings;
- Crack;
- fracture;
- Osteoporosis;
- Hemorrhage;
- Suspicion of abnormal development of the vertebrae;
- Osteochondrosis.
Training
Special dietary preparation will be necessary for patients undergoing a procedure with contrast: it is important to stop eating foods that may be the result of gas formation a day before the examination. You should not eat or drink water immediately 6 hours before the CT scan.
During the diagnosis, some internal organs of the abdominal cavity and the small pelvis fall into the area of \u200b\u200bexspection of the tomograph. For this reason, sometimes the doctor asks you to drink water an hour before the examination in order to bladder was full. This makes it possible to detect diseases internal organs and small pelvis during examination of the spinal column.
It is recommended to wear clothing free of metal objects, as they may adversely affect the quality of the pictures. Otherwise, an employee of the diagnostic center can provide a special medical gown with a request to change clothes.
How do they do it?
The patient lies on the movable table of the tomograph, which slides into the ring. There is a noise, the ring starts to rotate. Tomograph sensors make a huge number of sections that are sent to specialized computers, where a three-dimensional image is created.
The entire research process takes about 30-40 minutes.
After the end of the work of the tomograph, the patient is given images in his hands, with which he goes to the radiologist, who specializes in deciphering the images.
It will take a little more than an hour to decipher the pictures.
Pathology of the spine in the lumbar segment is extremely common. This is due to the peculiarities of the load on these parts of the skeleton. In connection with upright posture, it is the lumbar spine that undergoes the greatest age-related changes. With prolonged influence of factors that increase the load on the vertebrae in this zone, degenerative-dystrophic changes with severe symptoms develop. One of the most effective methods diagnosis of such a pathology is CT of the lumbosacral spine.
Why computed tomography?
A conventional x-ray, which is most often used to diagnose spinal pathology, is far from always informative. It allows you to evaluate only gross defects in bone tissue, revealing pathological changes only in advanced stages. The structure of the spinal cord, as well as the structural features of the soft nervous tissue, remain beyond the diagnostic capabilities of a simple X-ray examination.
CT in the pathology of the lumbosacral spine, although based on the same mechanism of action on tissues, nevertheless, allows you to obtain much more data on the pathological processes occurring in the affected bone segment. The essence of the technique is the study of layer-by-layer images obtained through the action of a tomograph. As a result, the following data can be analyzed:
- features of the structure of the vertebrae;
- the presence of hernial protrusions;
- whether there are protrusions - age-related defects in bone tissue;
- identify volumetric formations;
- assess the integrity of bone structures;
- determine the state of the spinal cord and the channel in which it passes.
As a result, there is a complex picture of disorders that have arisen in the lumbosacral segment of the spinal column. Since X-rays reflect the structure of bones very well, computed tomography in some cases surpasses even MRI in efficiency. Modern high-power devices that provide high-quality resolution for any pathology of the lumbar region, but also allow three-dimensional reconstruction of the changes found on the monitor screen. This helps the radiologist accurately assess the essence of the disease state.
When is the study ordered?
The essence of the technique is the study of layer-by-layer images obtained through the action of a tomograph.
Due to the wide possibilities and relative safety of the procedure, CT has many indications. These include both clinical situations faced by the doctor, and changes identified through other methods. The main indications for CT of the lumbosacral spine can be represented as follows:
- suspected vertebral fracture;
- tumors of the lumbar region;
- degenerative-dystrophic diseases of the spine, for example, osteochondrosis;
- spinal stroke;
- suspicion of a herniated disc in the lumbar region;
- lower paraparesis - to search for the cause of the disease state;
- persistent pain in the lower back without changes in other types of studies;
- the presence of neurological symptoms in the study of reflexes from the lower extremities.
The decision on the appointment of the study is usually made by the attending specialist, although many clinics offer the patient himself to undergo an examination on a paid basis. Computed tomography is included in the list of services paid by the system compulsory insurance citizens, therefore, if there are clinical indications, it is performed free of charge in outpatient settings.
How to properly prepare for a CT scan?
Diagnostic manipulation can be carried out both on an emergency basis and as planned. In acute conditions, for example, a suspected spinal fracture or spinal stroke, the procedure is done at the time the patient contacts, without any preparation. This somewhat reduces the objectification of the data obtained, but gross changes in the vertebrae and bone marrow are always detected.
During a planned study, the patient is advised to follow some rules so that the preparation for CT helps to accurately visualize the disease. They include:
Usually, CT in the pathology of the lumbosacral spine is performed without contrast enhancement.
- for 72 hours, follow a diet that prevents the accumulation of gases in the intestines, that is, it is not recommended to eat legumes, cabbage, black bread, a lot of flour products;
- for 24 hours completely exclude the intake of alcohol, including beer;
- since the study is usually carried out in the morning, you should come on an empty stomach;
- with constipation, as well as with a body weight of more than 80 kg, a cleansing enema is recommended before manipulation, preferably 2 hours before CT.
Before performing a tomography, it is necessary to inform the doctor about the presence of an allergy to any medicines, especially those containing iodine. If the study is carried out on a budgetary basis, you must take with you not only your passport and policy, but also SNILS. If you have previous CT scans, as well as conventional X-rays, you need to take them with you. This will help to reflect the dynamics of the state of the disease process.
How is the examination carried out?
Scheduled research is usually scheduled for the morning hours. It is advisable to arrive a few minutes earlier than the appointed time. Computed tomography in the pathology of the lumbosacral spine is performed in a special room equipped with diagnostic X-ray equipment. As a rule, it consists of 4 rooms:
- the place where the tomograph itself is located;
- a corridor for transporting patients, as well as waiting for research;
- the control room, where doctors and laboratory assistants work behind glass, separated from the tomograph itself;
- special rooms for staff, where the sick are not allowed.
The patient is located on the diagnostic multifunctional table lying on his back. After actuating it, it transports the patient to the area of the X-ray tube, which is a closed spiral. Usually, CT in the pathology of the lumbosacral spine is performed without contrast enhancement. But if the introduction of a substance is required, then it is injected using a special infusator, which is connected through a catheter in the cubital vein.
Then layer-by-layer images of the lumbar region are taken, with each vertebra being divided into numerous X-ray layers, which makes it possible to accurately verify the disease. The study lasts no more than 20 minutes. During this time, the patient must be immobile. After the manipulation, the patient goes out into the corridor, where he awaits the conclusion of a specialist.
Do not confuse the contrast agents used for CT and MRI of the lumbar segment of the spine. They are completely different! If you need to buy the contrast yourself, you need to clarify at the pharmacy what kind of manipulation the contrast is intended for. This will help prevent serious financial losses, since the diagnostic substance has a high price.
When is research not allowed?
CT can be performed both on an emergency basis and as planned.
Despite the relative safety, manipulation has some contraindications. These include:
- pregnancy;
- breast-feeding;
- radiation sickness;
- claustrophobia;
- mental disorders when the patient cannot lie still during the procedure;
- weight more than 130 kg, as damage to the diagnostic table is possible.
If it is necessary to perform the procedure for children or patients with mental illness, they are first administered a sedative. In difficult situations, when it is ineffective, it is possible to coordinate anesthesia with resuscitators. If you are allergic to a contrast agent, the procedure is performed without it. Pregnancy is an absolute contraindication. Since computed tomography is associated with radiation, the risk of damage to the fetus is extremely high. If there is an indication for an urgent study of the condition of the spine in the lumbar region, an MRI is prescribed.
Conclusion
So CT lumbar of the spine is a modern accurate method for diagnosing most of the pathological changes that occur in this area of the human body. In some cases, it is an indispensable alternative for the detection of diseases of the spinal column. Despite the safety and absolute painlessness of manipulation, there are serious contraindications. Before carrying out the procedure, it is imperative to know the opinion of the treating specialist, since the introduction of a contrast agent is often required.
Due to its high information content and availability, CT of the spine is widely used in diagnostics. various diseases and to evaluate the results of their treatment. X-ray tomography allows you to determine the cause of compression of the spinal cord (tumors, intervertebral hernias), identify abnormalities in the development of the spine, structural changes in the vertebrae (osteoporosis, fractures, deformities, osteophyte formation), infectious processes, hematomas, abscesses, foci of calcification. The technique is indicated for traumatic injuries of the spinal column, suspected primary tumor or metastases, for the diagnosis of persistent pain syndrome, to assess the condition of the spine after a spinal cord injury or surgical treatment. In neurology, CT of the spine is used mainly to study the bone structures of the spinal column, less often to diagnose the pathology of the spinal cord, intervertebral hernias, abscesses and hematomas.
Training
The preparation of the patient and the principles of the procedure are similar to those for computed tomography of other anatomical structures. Special preparation is necessary when examining the lumbar spine. In this case, for several days before the scan, the patient takes enzyme preparations and Activated carbon to clean the intestines, immediately before the start of the manipulation, a cleansing enema is put.
Among the hardware diagnostic methods, CT of the lumbosacral spine occupies a special place. Computed tomography allows you to see what is hidden from the doctor's eyes during a standard examination. What are its features?
If we consider the sacro-lumbar spine, the following situations may become the reason for a detailed diagnosis and appointment of a CT scan:
- Existing concerns. These are pains in the spine, heaviness in the lower back, backache in the coccyx area, the inability to fully bend and unbend, turn to the sides.
- Injuries. In particular, this applies to injuries directly to the lumbar spine and coccyx. Any fall, impact, sudden movement or heavy lifting can provoke a displacement of the vertebrae or a violation of their integrity.
- Numbness of the extremities and muscle paresis, lumbago. A feeling of coldness, "goosebumps", a violation of muscle control, especially of the lower extremities, may indicate a pinched nerve.
- Congenital anatomical pathologies. In such cases, constant monitoring of the patient's condition is necessary.
Recent treatment, problems of the musculoskeletal system, surgical interventions are a reason to get checked for CT.
Most often, the need to examine the spine is faced by people with a hereditary predisposition, athletes whose profession is associated with lifting weights or being on their feet for a long time.
What the study shows
Computed tomography allows a more thorough and detailed examination of the condition of bone, cartilage and partially soft tissues in the problem area. When examining the lower back, the vertebrae and intervertebral discs, bone marrow are clearly visible.
What this diagnostic shows:
- displacement of the vertebrae;
- cracks and fractures;
- pinching of nerve roots and blood vessels;
- intervertebral hernia and disc protrusion;
- osteophytes;
- thinning discs and cartilage;
- tumors and cysts;
- foreign inclusions;
- hemorrhages;
- metastases;
- spinal stenosis;
- rheumatic changes;
- arthrosis and arthritis;
- destruction of bone tissue, osteoporosis;
- anatomical anomalies.
Thus, thanks to CT, it is possible to consider the slightest changes in the structure of the tissues of the spine and neighboring areas. This makes it possible to find out the exact cause of lower back pain and other symptoms characteristic of the defeat of this zone. In particular, it is possible to timely detect neoplasms of both benign and malignant nature. If necessary surgical intervention the sacro-lumbar region can be examined in more detail in order to draw up a clear plan of action during the operation, and in the future, repeated images clearly demonstrate the results of the treatment.
Since the lumbosacral region is scanned completely, the doctor has the opportunity to examine the condition of the internal organs of the abdominal cavity and small pelvis. This allows you to identify problems that do not manifest themselves in any way, are not related to the main complaints, and eliminate them in time.
Preparation for the examination
In order for the results to be as reliable as possible, it is necessary to properly prepare for the passage of the computer diagnostic procedure. It is important to eliminate all possible interference in order to obtain a clear picture.
Proper preparation for CT should include the following activities:
- A few days before the diagnosis, it is recommended to switch to a diet to eliminate problems with the gastrointestinal tract, in particular those associated with increased gas formation.
- Drink plenty of water an hour before your scan to fill your bladder and open up your internal organs.
- Your doctor may recommend taking a carminative medication to help with gas and flatulence.
- The bowel must be emptied. In some cases, a cleansing enema may be required.
- A prerequisite is the restriction of food intake 5-6 hours before the procedure, that is, tomography is performed on an empty stomach.
There is nothing complicated in such preparation; many diagnostic procedures require compliance with such conditions. To get things right, after receiving your CT scan appointment, check with your doctor about the preparation requirements.
Methodology
The CT scan itself is also very simple in nature. It is carried out using a special device - a tomograph. The patient is placed on the table of the tomography scanner, to minimize movement during the examination, belts can be used to fix the body. Be prepared for the noise the device makes.
It is important that during the scan the person does not move, you need to breathe so that rib cage and my stomach didn't move at all. The examined area is translucent with the tomograph ring in different projections, which results in a layered picture of the sacro-vertebral spine. Any movement during the procedure will cause the image to be blurry and fuzzy.
The machine can also be used to view blood vessels. To do this, a contrast agent, usually based on iodine, is injected into the patient's blood beforehand. For a detailed study of the problem, diagnostics are often performed in two stages: first “dry”, and then with the introduction of contrast. It comes out after 1-2 days.
The total diagnostic time takes from 10 to 30 minutes.
Advantages and disadvantages
Computed tomography is popular because it has a lot of advantages. The advantages of this method are:
- high diagnostic accuracy;
- fast execution of the examination procedure;
- minimal risks for the patient;
- obtaining a three-dimensional image and video;
- the ability to consider small details when zooming in on the picture;
- the ability to detect diverse pathologies in both bone and soft tissues.
However, there are certain risks that may be the reason for refusing computed tomography. The disadvantages of this method include:
- X-ray exposure. Despite a small dose, frequent scanning is undesirable. In addition, some patients may not be eligible for CT for other reasons, such as health reasons.
- The use of a contrast agent. Iodine can cause side effects and also be contraindicated in people with thyroid problems. Allergic reactions are not excluded. In this case, the doctor should be warned about the characteristics of the body. In case of ignorance about a possible allergy, antihistamines are always on hand.
Otherwise, computed tomography has only advantages. In addition, it is worth noting the availability of this diagnostic method, as well as its lower cost compared to its analogue - MRI.
Differences from other methods of hardware diagnostics
If we compare CT with other methods, in many respects it is more preferable, but it is necessary to take into account the specific situation and diagnostic features. Compared with ultrasound and radiography, of course, computed tomography has many more advantages, as it allows you to better view the condition of the lumbar region. At the same time, an alternative to it is magnetic resonance imaging.
MRI, compared to CT, works by means of magnetic pulses rather than X-rays. In this case, it is possible to examine in more detail the condition of soft tissues, cartilage, and nerve endings. On the other hand, dense formations (osteophytes, renal calculi) and bone tissues are more clearly visible on CT. When diagnosing fractures and cracks, this is the best method. When examining for deviations in the blood supply or the presence of pathological neoplasms, in many respects, both methods are considered approximately equal.
Another advantage of CT compared to MRI is the openness of the examination. For an MRI, you need to be inside the machine itself, which can cause panic in some people. With claustrophobia, this procedure is contraindicated.
CT scan of the sacro-lumbar spine is an informative modern diagnostic method that allows you to identify problems at any stage of its development.
Short description procedures
Time spending: from 10 minutes, with contrast up to 30 minutes
The need for a contrast agent: as prescribed by the doctor
The need to prepare for the study: No
Presence of contraindications: Yes
Restrictions: available
Conclusion preparation time: 20-60 minutes
Children: over 14 years old
Features of the structure of the coccyx
The coccyx is the lower section of the spinal column, which contains 4-5 fused rudimentary vertebrae, designated Co1-Co5.
The anterior coccyx plays an important role in the attachment of ligaments and muscle tissues that are involved in the work of the distal large intestine and the genitourinary system. Also, some muscle bundles of the gluteus maximus muscle are attached to the coccyx, which are involved in hip extension. In addition to these functions, this structure is an important fulcrum involved in the distribution of the load on the pelvic elements.
Most often, this study can be prescribed in the following cases:
suffered injuries;
prolonged pain in the lower back, radiating to the lower extremities;
feeling of numbness and shooting in the legs.
Diagnosis can be indicated with ambiguous data obtained using classical radiography, and with symptoms of functional disorders of the pelvic organs.
What does a CT scan of the coccyx show?
Compared with other parts of the spine, the coccyx is less frequently examined by CT, because due to the lack of division into individual vertebrae, the formation of hernias is excluded in this area of the spinal column. Usually, CT of the coccyx is a clarifying procedure after the radiography is performed, as well as in cases where the x-ray is not able to accurately and accurately diagnose pathologies of the coccyx and sacrum due to the array of tissues located in this area.
As a result of layer-by-layer scanning, CT of the sacrum and coccyx allows obtaining a series of images of this area and neighboring tissues in two projections - from the side and from the front.
The most common disorders of the coccyx are cracks, fractures, other consequences of trauma, anomalies in the development of bone structures, and since CT successfully diagnoses pathologies of bone tissue, it is a reliable and effective method detection of these pathological changes. Thanks to CT, they assess the condition of the cartilage, the location of bone fragments after injuries, the characteristics of fractures of the coccyx with and without displacement of structures, the presence of hematomas, and also judge the degree of complexity of the injury.
Diagnostics also allows you to detect the presence of:
dislocations in the sacrococcygeal joint;
malformations;
ingress of soft tissues between fragments as a result of trauma;
tumor processes of the sacrum and coccyx, foci of metastasis;
osteochondrosis;
tuberculosis, septic, metastatic destruction of the sacrum;
osteoporosis;
various deformations of structures;
expansion or narrowing of the lumen of the end section of the spinal canal;
cauda equina syndrome.
Note that when examining violations of the coccygeal soft tissues, MRI will be a more informative method.
When is a contrast CT scan of the lower spine performed?
If it is necessary to visualize possible tumors and inflammatory processes, a contrast procedure for scanning the coccyx is performed. Penetrating into circulatory system, the radiopaque preparation stains the vessels, and since tumor tissues have an increased blood supply, they are perfectly visualized on CT scans with contrast.
Contrast CT of the coccyx determines the size, the exact location of the volumetric process, the degree of destruction and other parameters of the pathology. Thanks to contrast enhancement, differential diagnosis of cysts and tumors is also carried out.
Preparation and contraindications for CT of the coccyx
There is no special preparation for the study - you can take it the day before medications, eat food. If contrasting is necessary, some centers may ask the patient to come on an empty stomach, so this issue should be clarified with the clinic staff.
It is necessary to take a passport for diagnostics, if available - data from past examinations, for example, x-rays, a doctor's referral and other medical documents related to CT of the coccyx.
The patient must arrive at the medical center 10-15 minutes earlier - this time will be needed to draw up a medical contract and fill out a questionnaire indicating the existing contraindications. With non-contrast CT, this is pregnancy, in the case of a contrast study, an allergy to iodine, kidney failure, thyroid pathology, diabetes mellitus, multiple myeloma are added to this contraindication.
