MRI of the lumbosacral spine:which shows how much it costs

Update: November 2018

Magnetic resonance imaging (МРТ) сейчас является, пожалуй,
the most accurate method of imaging virtually any organ and
tissues of our body. While this method is less available than ultrasound
or CT, but in some cases it is irreplaceable.

The principle of diagnosis using MRI

The principle of this method is in the influence of a magnetic field on our
cells, or rather, the hydrogen atoms in them. ATодород у нас находится
primarily in water molecules (of which we are 80%),
that is, in almost all tissues.

Human помещают в сильное магнитное поле и дополнительно
affected by electromagnetic waves.

Under the influence of a magnetic field, hydrogen atoms line up
in a special way, and at the end of this impact they return to
the usual “relaxed” state. ATот это возвращение,
accompanied by the release of a certain amount of energy, and
fixes the equipment, and the image is formed in layers and from
several projections.

AT результате получается очень четкая картина строения
investigated organ and pathology present in it

Previously, this method was called nuclear magnetic resonance (NMR), but
the name was changed because the word “nuclear” caused radio phobia in
people.

In fact, MRI does not carry any harmful
radiation.

Contraindications to MRI

Any foreign bodies in the human body that are capable of
magnetization during this study can:

  • ATыйти из строя (кардиостимулятор или другое автоматическое
    device).
  • Heat and cause burns.
  • To shift.
  • Interfere with a normal image.

Absolute contraindications to the study:

  • The patient has an implanted
    pacemaker.
  • Metal clips on the brain vessels.
  • Insulin pump.
  • Cochlear implant.
  • Metal bodies in the body of non-medical origin
    (for example, steel chips in the eye).
  • Severe condition requiring resuscitation.

Relative contraindications

These are the conditions that need to be considered individually. AT
most cases with careful analysis of these contraindications
are removed (if the patient has on the hands of the conclusion with
physical characteristics of the implant).

  • Prosthetic joints.
  • Metal structures that fasten the vertebrae.
  • Dental implants and prostheses.
  • Artificial heart valves.
  • Condition after heart surgery (metal brackets on
    sternum).
  • Stents in vessels.
  • ATнутриматочные спирали.
  • ATенозные фильтры.
  • Claustrophobia.
  • Restless behavior of the patient.
  • Tattoos.
  • Body weight more than 130 kg.

Most modern implants and stents are compatible with
MRI studies. There are special sites where you can accurately
make sure the security or insecurity of a particular
material.

Patients with fear of confined space and incapable
for a long time to keep still (for example, children)
the study is conducted under general anesthesia. There are also devices
open type, they can examine patients with claustrophobia
as well as obese patients.

The role of the method in the study of the spine

Back pains are the second most common after colds.
diseases cause visits to the doctor all over the world. And of course,
the most common localization of back pain is
lumbosacral. Everybody experiences back pain
second adult, with age, this figure reaches 90%.

The main cause of back pain is
degenerative-dystrophic changes in the spine, protrusion and
disc herniation. However, this is not the only reason, there is a whole
a number of diseases manifested by this symptom.

What does x-ray show is until recently the only
The method of diagnosis of the spine was radiography. She is и сейчас
gives enough information:

  • in the pictures you can see the curvature,
  • размеры vertebrae,
  • their offsets
  • fractures of the body and processes
  • marginal bone growths (osteochondrosis),
  • снижение высоты межvertebraeой щели (косвенное свидетельство
    disc herniation).

X-ray does not allow to see:

  • disk status
  • spinal cord
  • narrowing of the spinal canal,
  • межvertebraeых суставов,
  • may not always consider cracks, metastases or
    tumors.

With the introduction in the last decades of the last century in medicine CT
and MRI, these methods have firmly taken the lead in pathology
spine.

Indications

An MRI of the lumbar spine is offered:

  • With spinal cord and coccyx injuries.
  • With persistent back pain, difficult to treat and lasting
    more than 1.5-2 months.
  • With the appearance of muscle weakness, numbness in one or both
    feet.
  • In case of dysfunction of the pelvic organs (urinary incontinence and
    kala).
  • If back pains have occurred in a cancer patient (for
    exclusion of metastases).
  • If the usual radiographs revealed pathological
    changes requiring clarification.

Little anatomy

The lumbar spine includes five powerful
vertebrae (L1-L5), выполняющих основную опорную и амортизационную
function. Each vertebra consists of a body and a bow. Handles vertebrae
form the spinal canal in which the spinal cord passes. AT
lumbar spinal cord ends at level 1-2
vertebrae, далее он продолжается «конским хвостом», который
is a cluster of nerves and spinal roots.

From the arc of a vertebra there are processes: spinous, two transverse and
four articular (upper and lower). Между телами vertebrae
расположен межvertebraeый диск, который представляет из себя
fibrous ring and gelatinous pulposal located inside
core.

ATследствие больших нагрузок, приходящихся на этот отдел
spine and loss of elasticity in the fibrous ring occur
breaks, it flattens. The pulpous core bulges into these eruptions,
so is a herniated disc. Hernia can squeeze like a nervous
the spine coming out of the spinal canal and the spinal cord itself
or horse tail.

Next, the lumbar region passes into the sacrum (5 intergrown between
собой vertebrae) и в копчик.

  • L – the so-called vertebrae of the waist.
  • S – Sacral Vertebrae.

Preparation and how is the MRI procedure

For the lumbosacral MRI procedure, a special
no training required.

  • Needless to worrying people
    tranquilizer.
  • It is not recommended to use cosmetics.
  • If the study is intended with contrast, the patient
    asked to come on an empty stomach.

It is necessary to bring direction, x-rays,
results of previous MRI examinations, if any
were carried out.

Как делают МРТ пояснично крестцового отдела spine?

Before the procedure, you must remove all metal
items – jewelry, watches, removable dentures, clothes with
metal clasps. AT некоторых клиниках просят снять с себя
all clothes and wear a disposable medical gown. The fact is that
clothes that are damp with sweat can also be heated in a magnetic field and
burn the skin.

The patient is placed on a special retractable table. On the area
abdomen is placed rf coil. AT уши вставляются беруши или
headphones, as the equipment produces a rather loud noise. Human
warn that for a while he will be alone in
closed chamber, do not move. When signs of bad
there is a button or a microphone inside the camera to communicate with
by the staff.

The table with the patient slides inside the chamber. No unpleasant
sensations the patient usually does not feel.

  • The lumbosacral examination lasts about 20
    minutes
  • About 30 minutes more, you need to wait for decoding and
    conclusion

The results are handed out in the form of a printed conclusion with
signature and seal of the doctor, printed out the most informative
snapshots, as well as a CD with survey information.

What diseases of the lumbar spine can
define

Что показывает МРТ поясничного отдела spine? Causes of pain
in the back – a lot, they can be divided into groups:

  • Degenerative-dystrophic changes are changes that
    lead to a gradual loss of physiological functions. Fabrics
    atrophy, aging, thinning or vice versa thickens:

    • it is osteochondrosis, protrusion and herniation of disks
    • в подавляющем большинстве межvertebraeые грыжи образуются
      it is in the lumbar spine.

      • 50% of hernias are detected in disk L5-S1,
      • 45% – in L4-L5.
  • Three-dimensional changes – fractures of the bodies, arches and processes,
    sprains, subluxations.
  • Первичные опухоли vertebrae и spinal cord а также
    metastases.
  • ATоспалительные процессы – остеомиелит, туберкулезный или другой
    spondylitis.
  • Смещения vertebrae (спондилолистез).
  • Myofascial syndrome (thickening of the yellow ligaments, tension
    muscle).
  • Спондилоартриты (изменения в межvertebraeых суставах).
  • Аномалии развития vertebrae и спинного мозга.

What is usually reflected in the conclusion

The description of the survey should include
information:

  • о плотности, высоте межvertebraeых дисков;
  • о форме и размерах тел vertebrae;
  • the size of the lumen of the spinal canal;
  • the state of the axis of the spine, physiological curves, the presence
    curvature;
  • bone marrow signal;
  • состоянии межvertebraeых суставов;
  • ligament thickness;
  • about the soft tissues surrounding the spine.
  • during protrusion and extrusion of disks, their size is indicated in
    millimeters, the direction of their dislocation;
  • смещение vertebrae отражается в процентах к длине нижележащего
    vertebra.

Stages of degenerative – dystrophic changes:

  • 0 — диск не изменен, введенное в контрастное
    the substance does not leave the boundaries of the pulp nucleus
  • 1 — контраст проникает до 1/3 фиброзного
    rings,
  • 2 — контраст на 2/3 фиброзного rings, имеются
    small ruptures of his plates
  • 3 — контраст до внешних пластин rings,
    crack throughout its radius, pains are already arising
  • 4 — контраст по окружности, но до 30°,
    radial gaps merge with concentric. Significant
    разрушение диска, но сохраняются наружные кольца фиброзного rings,
    preventing hernia formation. In addition to back pain, it is possible
    Irradiation to the legs to the knees.
  • 5 — контраст в перидуральном пространстве,
    cracks and tears along the entire fibrous ring, the disc bulges,
    the posterior longitudinal ligament is torn. It provokes autoimmune
    inflammation in the surrounding tissues, which causes inflammation of the nerve
    roots – radiculopathy.

Stages of disc degeneration

  • М0 – пульпозное ядро овоидной или шаровидной
    forms – the norm
  • М1 – локальное снижение степени свечения
  • М2 – нет свечения пульпозного ядра
    – disk degeneration

Phases of lesion of the vertebral bodies:

  • 1 тип — воспаление в костном мозге vertebrae,
    the signal intensity decreases by T1, the signal increases by
    T2
  • 2 тип — замена жировой тканью нормального
    костного мозга, увеличение сигнала и на Т1 и T2
  • 3 тип — указывает на процессы остеосклероза,
    уменьшение сигнала на Т1 и T2

What are the most common changes on MRI?

  • Herniated discs:
    • Protrusion is the break only of the internal fibers of the fibrous
      ring, it is visible as a slight disc bulging. She is
      regarded as the initial stage of the hernia. Treating her significantly
      lighter than intervertebral disc prolapse and less time consuming.
      Their size ranges from 1 to 5 mm.
    • Extrusion is the output of the pulp core through a complete break.
      cartilage ring, protrusion can be significant and squeeze
      nerve roots or spinal cord.
    • Sequestration is when the pulpous nucleus completely goes beyond
      disk limits, can move up or down, penetrate
      dura mater.
  • Spondylosis – hypertrophy of articular processes and overgrowth
    osteophytes, even without hernia, can lead to vertebral stenosis
    channel.
  • Spondylolisthesis – Described as a “slipping” picture
    one vertebra relative to the next due to cartilage defects
    tissue. The 4th vertebra is most often shifted relative to the 5th.
  • Метастазы в позвоночник — Метастазы в позвонки в 90%
    cases look like foci of destruction (destruction of bone
    ткани),  чаще встречаются в случаях рака молочной железы,
    lungs, kidneys. With metastases of the thyroid gland and prostate –
    очаги склеротические, то есть с уплотнением костной tissue.
  • Fibrous changes – replacement of any fibrous tissue, little
    functional stiff fabric.

Description of hernia and protrusion

Sizes of protrusion and hernia of the lumbar spine

  • 1-5 мм — маленькая протрузия. Treatment in
    at home – special gymnastics, outpatient –
    spinal traction.
  • 6-8 мм — средняя грыжа. Ambulatory treatment,
    operation not shown.
  • 9-12 мм — большая грыжа. Urgent outpatient
    treatment, operation only with signs of spinal cord compression,
    horsetail items.
  • свыше 12 мм — секвестрированная грыжа
    или большой пролапс. With a number of MRI – signs and compression
    spinal cord – urgent surgery. Outpatient treatment can be if
    in case of a compression of the brain and the horse’s tail, the patient will be able to
    the next day to get an operation.

A smaller hernia against the background of a narrowing of the spinal canal leads
yourself as bigger.

Bulging disc is considered:

  • значительно выраженным, если оно более 15-25%
    anteroposterior spinal canal diameter
  • или до 10 мм сужает канал (критический
    level).

How MRI is different from CT

To most non-medical people, these two ways
seem to be the same thing. The total in them only the word “tomography”
(which means layered image), yes the external similarity
devices.

CT scan Magnetic resonance imaging

Physical exposure method

X-rays

Magnetic and electromagnetic field

Organs examined

Not bad diagnoses and often sufficient in the study of organs.
respiratory, abdominal, bone.

More preferable in case of multiple injuries (fractures are better visible).
and hematomas) and to rule out hemorrhagic stroke

Better identify problems with the brain and spinal cord,
joints, soft tissues, spinal structures, organs
pelvic well looking vessels

Duration

A couple of minutes

20 to 120 minutes

Contrast

Contrasts used can cause an allergic reaction.

Gadolinium-containing contrasts, rarely used, allergic
almost do not cause

Restrictions

Pregnancy, childhood, contrast allergies

Metal and electronic implants, mental
violations

Availability

More available

Higher cost, less available

Key questions that may arise

Should I get an MRI on my own for the first time the pain
in back?

No, this is not necessary. In most cases, acute pain in
back due to muscle spasm, rough pathology can
exclude the usual x-ray. With the passage of MRI without evidence
especially suspicious persons may receive a reason for heightened alarm,
because in the conclusion reflects everything, even meaningless
deviations. For example, identifying Schmorl’s hernias is almost always
accidental finding, no health hazards
present.

This survey is worth passing only on the recommendation
neurologist, vertebrolog, neurosurgeon or oncologist.

If a herniated disc is detected, you need to go immediately to a neurosurgeon at
an operation?

Only 10% of intervertebral hernia is operated. Mostly they
treated conservatively with success (see hernia gymnastics
lumbar). You need to go to the neurologist, if necessary he
he will direct to consultation of the neurosurgeon. MRI conclusion not
is the diagnosis, the diagnosis is made by the doctor.

Can I get an MRI for free?

Yes, you can get a lumbar spine MRI for free
under the policy OMS. The disadvantage is usually a routine examination.
there is a queue. But there is always time in the clinics.
cases of urgent diagnosis.

How much does a lumbosacral MRI cost?
spine?

The price of an MRI study of the lumbar spine depends
from the rank of the clinic, the power used tomograph, application
of contrast.

The lowest price for research in this area is from 2500 rubles.
The use of contrast increases the cost at least twice.

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