The decision of when to do an MRI for patients with low back or neck pain depends upon assessing the risk of a serious condition being present as revealed by warning symptoms in the history or signs in the physical examination.
How does an MRI Machine Work?
Unlike traditional x-rays or computerized axial tomography otherwise known as CT Scan, MRI (Magnetic Resonance Imaging) does not use any radiation and thus as far as scientifically known, it is much safer than x-rays. The patient is placed in a very strong magnetic field which causes the hydrogen protons in the body to become excited and because the magnetic field applied is uniform, these protons become similarly aligned. The magnetic field is rapidly turned on and off repeatedly which causes the protons to relax and emit radiofrequency waves. From this change the MRI machine can compute a picture of the tissues of the body particularly the brain, spinal cord, major nerves and other soft tissues. MRI detects slight differences in water content in soft tissues to detect abnormalities.
What Abnormalities can an MRI detect?
The MRI can show derangments from normal anatomy including:
MRI is superior to CT Scan in evaluating disorders of the spine as regards nerve compression. However sometimes CT Scan is needed to evaluate fine detail in the vertebrae because cortical bone, the tough outer layer of bone, has a low water content.
The Importance of Warning Symptoms or Signs:
The vast majority of neck or low back pain sufferers will improve without surgery. Only about 2% will ever need an operation. A physician can usually determine the potential seriousness of a condition causing pain by obtaining a detailed history and performing a thorough examination. If there are no warning symptoms or signs in the history or physical findings suggestive of a dangerous condition, then for most patients an MRI is not necessary before a trial of conservative treatment for at least a month.
Symptoms that the patient experiences or has in the history which may indicate a serious condition include:
Signs on examination which may indicate a serious condition include:
Which Area of the Spine should be Studied?
Most of the time patients with cervical spine problems have neck pain and upper extremity complaints while those with lumbar spine problems have low back pain and lower extremity complaints but sometimes it is not so clear.
Pain at the level of the shoulder blades can come from the lower cervical spine or upper thoracic spine. Generally if it also radiates to the arm then it comes from the cervical spine. Pain from the lower thoracic region can be similar to pain from the lumbar spine. If there are significant signs of lower extremity weakness, increased reflexes, bladder, bowel, or sexual dysfunction in a setting where the patient complains of low back pain then it may be wise to do a thoracic MRI if the lumbar does not show the cause. Similarly a very low cervical problem or high thoracic problem be hard to localize with a study of only the cervical or thoracic spine alone.
Most MRIs of the cervical usually show the lower brain so lesions near the junction of the cervical spinal cord and brain are usually identified somewhat on cervical MRI.
To know the need to go for an MRI, consult a spine health specialist online --> https://www.icliniq.com/ask-a-doctor-online/spine-health-specialist
The following conditions may necessitate a doctor to order a neck MRI (magnetic resonance imaging):
Neck ache that persists over time.
Existence of ongoing discomfort in the legs, arms, and shoulders.
Having pain after engaging in vigorous exercise or strenuous activity.
A cervical spine MRI can find several disorders in the neck and upper back, including issues with the spinal cord, nerves, and disks, which are soft tissues within the spinal column.
If the doctor believes that the reason for the low back discomfort is something other than a simple muscle strain, they may advise getting an MRI. This may be the case if the patient's medical history and physical examination indicate the presence of a significant issue, such as a fracture, tumor, infection, or damage to the patient's nerves.
An impingement or pinching of a nerve as it leaves the spinal cord frequently manifests as neck or low back pain that spreads into the arms or legs. Before irreversible nerve damage occurs, an MRI may be able to spot structural lesions that may be pressing against the nerve and help treat the issue.
A lumbar spine MRI can show various abnormalities in the lower back, including issues with the bones (vertebrae), soft tissues (such as the spinal cord), nerves, and disks.
The neck region may be covered with coils, unique devices that enhance image quality. The complete body of the patient will be slid into the magnet by the scanning table. Although they will not feel anything, they occasionally hear buzzing, pounding, clicking, and knocking noises during the scan.
The doctor typically receives complete results in one to two days. Even though the size and shape of a tissue or organ appear normal, an MRI can occasionally detect a problem in that tissue or organ.
Although general anesthesia is occasionally used, MRIs under anesthesia are often performed while the patient is sedated. Sedation is defined as being between being relaxed and being extremely sleepy but not entirely unconscious.
Patients are advised not to eat or drink before procedures to get better and clear images. Thus, making the result more accurate.
An abnormal MRI indicates that the scan does not reveal a healthy organ. In addition to structural damage that could suggest an injury, the scanned image might also exhibit lesions, inflammation, swelling, and bleeding.
Depending on the size of the area being scanned and the number of images being obtained, an MRI scan can take anywhere from 15 minutes to 90 minutes and is a painless procedure.
The powerful magnet of an MRI exerts pressure on fluid moving through the balance center of the inner ear, giving the impression of sudden or jerky movement. In addition, some MRI scans require a contrast agent injection (dye). As a result, specific tissues and blood arteries become more distinct and detailed. Side effects of the contrast agent include feeling or being ill.
Claustrophobic patients may develop panic episodes during an MRI if they are not given suitable accommodations, which can cause uncomfortable symptoms like chills, sweat, an elevated heart rate, and difficulty breathing. As much as 5 % of the population suffers from claustrophobia, making it a prevalent condition.
A computed tomography (CT scan) may be suggested if a patient cannot have an MRI. Patients with pacemakers, metal implants, or other implanted devices should avoid getting an MRI because of the powerful magnet inside the machine. CT scans generate images of soft tissues and hard tissues like bones.
Last reviewed at:
19 Jul 2019 - 3 min read
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