The Role of X-ray, CT Scan and MRI in Diagnosis of Spine Injuries - Research Paper Example

The role of X-ray, computed tomography and Magnetic Resonance Imaging in diagnosis of spine injuries Introduction Vertebral anatomy is becoming one of the most studied areas. It had been already proved that the state of the whole organism is highly dependent on the state of the spine. That is why spine injuries cause a lot of diseases, which usually can’t be connected to spine because of lack of knowledge and consequently the appropriate treatment can’t be prescribed. The person may have gone through spine injury many years ago and it seemed to be cured but it consequences caused another problems with health. The term “instability” is usually applied when we speak about traumas that have serious consequences. It is very essential to foresee instability in an individual who went through spinal damage, because such cases need stabilization that can prevent further more serious damage or chronic problems with health, which may occur. The stress should be made on a comprehensive and full analysis of spinal instability caused by trauma in order to plan medical intervention, which is needed to prevent further damage. Therefore, it is important to study the ways to reveal or predict instability. With the development of computed technologies developed techniques to predict the instability were proposed1 During the past decade the methods of examination of patients changed greatly. The imaging inspection of patients with spinal injury has been recently developed, and the one of the most important questions, which appeared during this development, is the post-traumatic spinal instability and the ways to predict it. In the past radiography represented a recognized and widely used technique for initial evaluation. However, in the United Stated computed tomography was introduced not only as a tool for additional examination but also for initial evaluation for cervical injuries. Computed tomography appears to be the best tool for cervical injuries examination. Magnetic Resonance Imaging technique is also widely applied for the revealing and cure of post-traumatic spinal instability. These injuries, once revealed, require special attention, however, it is very important to identify them first. 2 Recent improvements in imaging tools are productively used for the diagnostics of injury to receive precise and clear information. However, some areas remain doubtful, because of the lack of knowledge about the function of computed tomography and Magnetic Resonance Imaging. The lack of knowledge about what technique to use and how to determine the advisability of the usage can lead to serious problems. Unfortunately, many specialists remain poor-qualified in terms of application of the new techniques and interpretation of the results. Therefore, this area of medicine requires more study. The question is worth-discussing, therefore, in the given paper I will present the overview of the literature on the given topic and the summary of the most valuable articles in order to define important questions, which need special attention in study of spine injuries and post-traumatic spine instability. The literature were studied during two weeks, 50 articles were defined after reading abstract and the introduction and five articles were chosen as the most valuable for the review. The articles reflect the issues I consider to be very essential: the application of radiography, CT and MRI, advantages of the new technology, cautions. 1. Regnicolo, Luana, Messori, Anna, Polonara, Gabriele, Burroni, Elisabetta, Perugini, Silvana Salvolini, Ugo. 2002. MRI assessment of post-traumatic spinal instability. European Journal of Radiology 42: 154-159; The first work to analyze is the research presented by Luana Regnicolo, Anna Messori, Gabriele Polonara, Elisabetta Burroni, Silvana Perugini and Ugo Salvolini titled “MRI assessment of post-traumatic spinal instability”. The imaging inspection of patients with spinal injury has been recently developed, and the one of the most important questions which appeared during this development is the post-traumatic spinal instability and the ways to foresee it. In this paper scientists analyzed the information of 50 individuals with the abovementioned diagnosis. The authors made a conclusion that Magnetic Resonance Imaging data can present a full analysis of damage in a definite patient and help plan medical intervention. The term “instability” is usually used when we talk about traumas that leave serious traces. It is very important to forecast instability in an individual who went through spinal damage, because such cases need stabilization that can prevent further more serious damage or chronic problems with health, which may occur. Therefore, it is important to study the ways to foresee instability. With the development of computed technologies developed methods were created. This full analysis of the instability should be implemented in order to plan appropriate treatment especially if surgery is needed. The article “MRI assessment of post-traumatic spinal instability” describes a study of one of such techniques - Magnetic Resonance Imaging. The outcomes considerably proved the correctness of the information on Magnetic Resonance Imaging available in scientific works. It was revealed that spinal instability appears to be really frequent phenomenon: “All of the 50 spines resulted instable also according to Daffner et al.’s method; all five signs were present in 6% of the patients, four signs in 20%, three in 36%, two in 22%, and only one (which always was disrupted posterior _ertebral body line) in 16%”3 Magnetic Resonance Imaging data completely changed the statistics of spinal injuries. However, the authors of the given article themselves consider this research to be preliminary, because their goal was just to prove the practicability and effectiveness of Magnetic Resonance Imaging technique for the revealing and the cure of post-traumatic spinal instability. The present research could serve as a basis for further investigations, which should be held in order to show that right diagnosis that is recognized as the most important in medical practice could be made with the help of Magnetic Resonance Imaging technique. Also this research can be used as a basis for medical practice. According to the authors, it is really important to consider the information ‘horizontally’ and to complete it when preparing to the definite case supervision. Scientists state that the stress should be made on a comprehensive and full analysis of spinal instability caused by trauma in order to plan medical intervention, which is needed to prevent further damage. Magnetic Resonance Imaging that provides important data about the trauma represents a really valuable technique for spinal injury analysis implementation. 2. Grenier et al. 2005. Lumbar MRI Part 1: Normal imaging appearance of the lumbar spine. Clinical Chiropractic 7: 205-215; The second work to discuss is “Lumbar MRI Part 1: Normal imaging appearance of the lumbar spine”. This given work is worth-discussing because it presents a concise analysis of MRI of lumbar spine, which can be used by any doctor. A fundamental review of MRI lumbar procedures as well as common application of MRI is discussed. Normal state is compared with state of trauma and pathology. The authors Julie-Marthe Grenier, Peter J. Scordilis and Michelle A. Wessely also recognize MRI as very useful way of lumbar spine inspection. They also state that it is essential to know how and when this technique should be used in order to get the most valuable data. Revealed information allows to implement proper analysis of this technique. The authors recognize the MRI tool as the most valuable: “MR imaging is well established as an imaging modality in the assessment of the lumbar spine. In many situations it is preferred over computed tomography (CT) and myelography. Magnetic resonance imaging has been shown to be superior to both these modalities in the evaluation of degenerative disc conditions, infections, spinal neoplasms and intrinsic cord diseases. It allows visualization of both components of the intervertebral disc and direct imaging of the bone marrow. Computed tomography may only show an advantage over MRI for the evaluation of post-operative stenosis due to arthrosis; however, CT does not allow for distinction between post-surgical fibrosis/scarring and a recurrent disc lesion even with the use of intrathecal contrast agents” 4 The very important note the authors made is that MRI should be used cautiously. Notwithstanding that the tools is recognized as rather secure, it is necessary for the doctors to be familiar with cautions. It is necessary to be careful with individuals with mental diseases and pregnant women. It is essential that the procedure is comprehensively described to the individual with the purpose to reduce the risk of panic attack. It is also necessary to offer the patients some alternatives, helpful tools to provide them with more comfort. The images should be high-quality. The authors defined three cases when Magnetic Resonance Imaging is really needed. the necessary data can’t be received by other means; the information the can be revealed during Magnetic Resonance Imaging could influence the care of the individual; the doctor is sure that MRI is needed. The research proved that Magnetic Resonance Imaging represents a method, which can offer valuable data about normal and abnormal state of tissues. It is very important to know normal visual state of tissues in order to recognize abnormality. However, the authors warn: notwithstanding that Magnetic Resonance Imaging can give valuable data, a doctor always must compare this information to the data received from the preliminary medical examination in order to determine the significance of the information received. 3. Daffner, Richard H., Daffner, Scott D. 2002.Vertebral injuries: detection and implications. European Journal of Radiology 42: 100-116; In the article titled “Vertebral injuries: detection and implications” Richard H. Daffner and Scott D. Daffner not only state that spinal injuries can be predicted, but explain how that should be made. Such damages have definite “indications” that can be revealed. The given article provides the valuable information about the mechanism of spinal damages and their “indication” revealed with the help of radiography and computed tomography. Computed tomography was used mainly for cervical damages and radiography was applied for the entire spine. During the past decade the methods of examination of patients changed greatly. In the past radiography represented a recognized and widely used technique for initial evaluation. However, in the US computed tomography was introduced not only as a tool for additional examination but also for initial evaluation for cervical injuries. The authors widely discuss the problem of instability. According to them, “the subject of stability following a vertebral injury is a source of controversy among those physicians who treat spine-injured patients. Stability is defined as the ability of the vertebral column to not only maintain support for the head and torso, but also to protect the spinal cord and nerves under normal physiologic stress. Stability is dependent not only upon the bones but also upon the posterior third of the intervertebral discs, facet joints, and most important, the ligaments. Unstable injuries by definition are those that have the potential to cause or worsen neurologic symptoms or to produce skeletal deformity under normal physiologic motion.” 5 Computed tomography appears to be the best tool for cervical injuries examination. These injuries, once revealed, require special attention. The authors present the examination of 879 individuals with cervical damages. The outcomes were properly classified by the scientists. The results were divided into two groups: “major” and “minor”. The first group includes the damages, where instability was found with the help of radiographic or computed tomography detection, while the second group includes the injuries without instability according to the results of radiographic or computed tomography detection. The selection criteria are specially listed in the table. The damages are distinguished due to different injury mechanisms clearly explained by the scientists: “There are many classifications of the vertebral injuries in the medical literature….there are four main injury mechanisms: flexion, extension, rotary, and shearing. Any of these mechanisms may be combined, particularly as the result of secondary impacts that can occur, such as when an individual is thrown from a motor vehicle.”6 This article represents a real value in terms of study of vertebral anatomy, vertebral injuries, abnormalities and instability. 4. Tins B.J., Cassar-Pullicino V.N. 2004. Imaging of acute cervical spine injuries: review and Outlook. Clinical Radiology 7: 865–880; The next article to discuss is “Imaging of acute cervical spine injuries: review and Outlook” by B.J. Tins, V.N. Cassar-Pullicino. The article is very valuable because its main goal is to study the gaps of knowledge about the spinal injury diagnoses and fill the gaps with important information. Recent improvements in imaging tools are productively used for the diagnostics of injury to receive precise and clear information. However, the authors argue that some areas remain doubtful, because of the lack of knowledge about the function of computed tomography and Magnetic Resonance Imaging. The given work thoroughly investigates the important issues connected with old and new concepts. The main goal of the given work is to define advantages and disadvantages of imaging tools and how and when they should be used. Notwithstanding that there is a great number of useful literature, the remaining unanswered questions create significant gaps in knowledge. The study finds these gaps and tries to fill them with necessary answers. The results may be used as a base for further investigations in this area, moreover they may serve as motivation for further research. Usually the work and efficiency of the imaging techniques represents the focal point of the investigation and the appropriate attention is not paid to two essential fundamentals of any evaluation– the decisive factor and the level of the expert’s knowledge. The authors state that “A clear understanding of the indications for and technical aspects of the procedure is essential for a successful and complete examination” 7The scientists also emphasize the importance of right selection of the diagnostic tool and note that this selection should be made carefully and depending on the kind of trauma. In conclusion the authors of the article “Imaging of acute cervical spine injuries: review and outlook” state that imaging tools can fail to notice considerable spinal damages, and this may have negative consequences for many patients. Damages are overlooked mainly because of technically bad tools as well as the mistakes made by the poor-qualified individual during image explanation. The selection of the imaging technique has to be made in correspondence with the clinical examination of patients and techniques accessibility. It should be made accurately, because what is used for one patient should not be applied for another: “The choice of imaging protocol as a whole still has to be addressed. Both cost and increased radiation dose need to be considered versus the degree of risk of a missed spinal injury that we as a society are prepared to accept” (Tins and Cassar-Pullicino, 2004) 8The authors advise experts to take part in planning processes in order to be aware of all the results and improvements. Bono, Christopher M., Heary, Robert F. 2004. Gunshot wounds to the spine. The Spine Journal 4: 230-240; The article by Christopher M. Bono and Robert F. Heary, “Gunshot wounds to the spine” represents a great value because it is discussing a very relevant issue. Unfortunately, the criminal statistics has risen during last years. Every day a lot of people are injured severely and shooting injuries became very frequent. Spinal shooting wounds represent one of the most disturbing injuries, which usually have serious consequences and prevent patients from normal life. The article emphasizes the importance of the right diagnosis and makes the overview of different imaging tools in order to define the best techniques to apply. The authors note that the cure of shooting spinal wounds has a lot of peculiarities. The trouble is that it is very difficult to determine if such wound requires surgical intervention. Shooting injuries to the spine represents a real problem for medicine that needs urgent solution. Notwithstanding that such trauma prevention is the best solution to the problem, in the modern world we can’t rely on it and the effectiveness of cure depends upon knowledge about principles of injury, tissue and right diagnosis. The authors note that “Bullet removal caudal to the T11 vertebra can improve motor recovery. Regardless of the level of injury, corticosteroid infusion has little effect on neurologic improvement”.9 According to the authors of the article “Gunshot wounds to the spine”, Magnetic Resonance Imaging is not the best tool that can be applied in cases of shooting spinal wounds. They state: “The use of magnetic resonance imaging (MRI) to evaluate gunshot wounds to the spine is controversial. Bullet migration from the pull of the strong magnet can possibly lead to further neurological or soft tissue damage. However, numerous reports of the use of MRI after gunshot wounds to the spine have not supported this concern. The advantages of MRI over CT include markedly less artifact, better soft-tissue imaging and coronal, sagittal and axial visualization of the neural elements. Although these advantages are attractive, the use of MRI should be on an individual and patient-specific basis.”10 The authors state that the best techniques, which can be used for the diagnosis of shooting spinal injuries, are radiography and computed tomography. Conclusion In conclusion, it is essential to note that more attention should be paid to the comprehensive and full analysis of spinal instability caused by trauma in order to plan medical intervention, which is needed to prevent further damage. Recent improvements in imaging tools are used for the diagnostics of injury to receive precise and clear information. However, some areas remain doubtful, because of the lack of knowledge about the function of computed tomography and Magnetic Resonance Imaging. Magnetic Resonance Imaging that provides important data about the trauma represents a really valuable technique for spinal injury analysis implementation. The research proved that Magnetic Resonance Imaging represents a method which can present valuable data about normal and abnormal state of tissues. It is very important to know normal visual state of tissues in order to recognize abnormality. However, notwithstanding that Magnetic Resonance Imaging can give valuable data, a doctor always must compare this information to the data received from the medical analysis in order to determine their significance. Moreover, Magnetic Resonance Imaging is not the best tool that can be applied in cases of shooting spinal wounds. The best techniques, which can be used for the diagnosis of shooting spinal injuries, are radiography and computed tomography In many cases spinal injuries can be predicted. Such damages leave definite “indications” that can be revealed. The “indications” can be revealed with the help of radiography and computed tomography. Computed tomography is used mainly for cervical damages and radiography is applied for the entire spine. Imaging tools can fail to notice considerable spinal damages, and this may have negative consequences for many patients. Damages are overlooked mainly because of technically bad tools as well as the mistakes made by the poor-qualified individual during image explanation. The selection of imaging technique has to be made in correspondence with the clinical examination of patients and techniques accessibility. It should be made accurately, because what is used for one patient should not be applied for another. In order to gain necessary knowledge, experts should take part in planning processes to be aware of all the results and improvements. Bibliography 1. Biancheri et al. 2003. Imaging in spine and spinal cord malformations. European Journal of Radiology 50: 177-200 2. Blouin et al 2003. 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