Functional tests of the spine. Some functional tests to help the neurologist

The complex of neurological coordinating tests included the following tests:

1) maintaining balance in a simple and complicated Romberg position for 10 seconds. (to assess the ability to maintain a given position);

1) various modifications of the finger-nose test, including loading (after rotational multidirectional movements of the hands and head turns) - alternating hits of the index fingers of both hands into the tip of the nose with eyes closed, performed in vertical and horizontal positions, 5 attempts with each hand. At the same time, sequential testing, standing and lying, allows you to assess the degree of influence of the gravitational factor on the coordination of movements. Dosed load of low intensity characterizes plasticity

coordinating sphere, i.e. her reaction to a change in a particular situation;

3) heel-knee test - alternately hitting the knees of opposite legs with the heels, followed by movement along the front surfaces of the legs, 5 times with each leg;

4) a combined assessment of these samples is necessary to identify dissociation between the upper and lower limbs when performing specified movements);

5) finding the middle of the centimeter tape along its unmarked side with fixation of deviations - centimeters, 5 alternating attempts with each hand (to characterize the participation of the visual analyzer in the implementation of precise movements).

We evaluated the obtained data according to a special scale developed at the Department of Rehabilitation and Sports Medicine of the Russian State Medical University:

a) for the complicated Romberg pose: - stable balance - 0 points; - deviation of one hand - 1 point; deviation of both hands - 2 points; - deviation of the head - 3 points; general instability - 4 points. Inability to maintain balance - 5 points;

6) for finger-nose tests: - accurate hit on the tip of the nose - 0 points; hit within the nose without crossing the central axis - 1 point; hit within the nose with the intersection of the central axis - 2 points; - hit within the face from the side of the same name - 3 points; - hit within the face from the opposite side - 4 points; - past the face - 5 points;

c) for the heel-knee test: accurate hit on the knee and dribbling on the lower leg - 0 points; inaccurate hit in the knee, smooth dribbling on the lower leg - 1 point; accurate hit in the knee, uneven dribbling on the lower leg - 2 points; overshooting and dribbling within a limb - 3 points; slipping beyond the limits of the limb or slipping of the heel when driving along the shin - 4 points; impracticability of the test - 5 points.

The scale we used makes it possible to analyze not only the degree of deviations in the performance of one or another coordinating test, but also their number. In addition, it makes it possible to characterize the patient's asymmetry.

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What is a spine x-ray?

SYSTEMIC MANIFESTATIONS

Eye damage

The most common systemic manifestation is acute anterior uveitis (acute iritis or iridocyclitis), which occurs in 25-30% of patients. Eye damage, as a rule, is unilateral, recurrent, manifested by pain, photophobia, visual impairment, sometimes precedes joint damage.

Defeat of cardio-vascular system

Cardiovascular involvement sometimes occurs in severe ankylosing spondylitis with peripheral arthritis. Aortitis of the ascending aorta leads to dilatation and insufficiency of the aortic valve. In young people with minimal manifestations of spondylitis, the development of acute aortitis with rapid myocardial dysfunction has been described. Fibrosis of the subaortic regions can cause conduction disturbances and even complete transverse heart block.

Lung damage

Lung involvement is rare. The most characteristic is the development of slowly progressive fibrosis of the apex of the lungs (apical fibrosis), sometimes complicated by secondary infection and the formation of cavities.

Kidney damage

Kidney damage in the form of IgA nephropathy and amyloidosis is a very rare systemic manifestation.

Neurological disorders

Neurological disorders are also rare. Cauda equina syndrome, which develops as a result of a lesion of the hard shell spinal cord, leads to dysfunction of the pelvic organs, subluxation of the atlantoaxial joint - to compression of the spinal cord.

Clinical functional tests

Symptoms for identifying inflammation in the sacroiliac joint:

symptom of Kushelevsky (I): the patient lies on his back, on a hard surface, the doctor presses on the pelvic bones from above. In the presence of inflammation in the sacroiliac joint, sharp pain in the region of the sacrum;

symptom of Kushelevsky (II): the patient lies on his side, on a hard surface, the doctor puts his hands on the pelvic bone and presses hard on it, the patient feels a sharp pain in the sacrum;

symptom of Kushelevsky (III): the patient, lying on his back, bends one leg at the knee and takes it to the side, the doctor rests one hand on the bent knee, the other on the pelvic bone on the opposite side, in the presence of Bechterew's disease, a sharp pain in the sacrum;

Makarov's symptom - pain when tapping at the paravertebral points with the help of a hammer in the sacral spine.

Diagnostic tests to detect spinal lesions in Bechterew's disease:

pain when probing the paravertebral points;

symptom of Zatsepin - pain with pressure at the places of attachment to the spine of the X, XI, XII ribs;

Vreshchakovsky's test - the patient stands on his feet, his back is turned to the doctor, who puts both palms just above the pelvis and tries to put pressure on the stomach, with inflammation of the joints of the spine, the abdominal muscles are tense;

Forestier's symptom - the patient is placed against the wall, closely touching the heels, torso, head. Normally, heels, shoulder blades and the back of the head should touch the wall, if touching at any one point does not occur - Bechterew's disease;

determination of mobility in the cervical spine - 8 cm are measured upwards from the VII cervical vertebra and a mark is made, then they are asked to tilt their head down as much as possible. At healthy people the distance changes by 3 cm, in patients with lesions cervical spine distance does not change;

chin-sternum test - with a lesion of the cervical spine, the patient cannot reach the sternum with his chin;

Ott test - used to determine mobility in thoracic region spine. 30 cm are measured down from the VII cervical vertebra, a mark is made, and then the patient is asked to bend forward as much as possible. In healthy people, the distance increases by 5 cm; in people with lesions of the thoracic spine, it remains unchanged;

determination of restriction of movement in the chest - with a centimeter tape measure the girth of the chest at the level of the IV rib on inhalation and exhalation, the difference in a healthy person is 6-8 cm, in persons with limited movement - 1-2 cm;

Schober's test - to detect movement disorders in the lumbar spine. From the V lumbar vertebra, 10 cm recede upwards and make a mark, with maximum slope forward distance increases by 4 - 5 cm, in case of impaired mobility - does not change

The wide spread of spinal diseases among the population requires accurate diagnosis of these pathologies. And, despite the emergence of new informative diagnostic methods, radiography remains the most common examination of the musculoskeletal system, including the spine. This procedure can be applied to all parts of the spinal column. X-ray of the lumbosacral spine needs to perform preparatory procedures in compliance with simple rules.

What is the purpose of radiography

Apparatus for X-ray

The method is based on the ability of tissues to varying degrees to transmit X-rays, which are fixed on a special film located behind the patient's body. In front there is a source of radiation - an x-ray tube. Bone structures transmit less rays, so the film opposite them has a whitish color. soft tissues and organs containing air (intestines, lungs) give a darker tint on the film. Since an x-ray is an image negative, radiologists call light elements on it blackouts, and dark ones - enlightenments.

Benefits of radiography:

availability; low cost; ease of implementation; informative value in assessing bone structures.

Disadvantages of the X-ray method:

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rather low information content when visualizing muscles, discs, ligaments, soft tissues; difficulties in assessing the state of the structure of intervertebral discs; the harmful effects of x-rays.

Intervertebral hernias are difficult to diagnose using a classic X-ray, so it is better to perform an MRI diagnosis.

When is a spinal x-ray needed?

Indications for x-ray of the lumbosacral spine are:

traumatic injuries; deformities of the spinal column; pain in the lumbar region and sacrum; numbness, paresthesia in the lower extremities, leg muscle cramps; primary or secondary (metastatic) malignant processes in the bones of the spine; benign neoplasms of the vertebrae; suspicion of rheumatological diseases affecting the spine ( for example, Bechterew's disease); infectious lesions of the spine (tuberculosis, syphilis, osteomyelitis); diagnostics before and after surgery; control of the dynamics of the disease during treatment; congenital pathologies of the development of the spine.

The indications are determined by the local therapist, neurologist, orthopedic traumatologist or vertebrologist. To undergo an x-ray, these specialists issue a direction, where they indicate the area of ​​\u200b\u200bthe spine and the projections necessary for performing the study.

Contraindications for x-ray

Despite the many advantages of this method, radiography of the lumbosacral spine has a number of contraindications:

X-rays are not recommended for pregnant women.

pregnancy; lactation period; children under 14 years of age (strict indications of a doctor); movement disorders; mental states with severe arousal; high degree of obesity; fluoroscopy performed the day before using barium.

These contraindications can be relative, especially when there is no other way to diagnose. If we are talking about excess body weight or the inability to achieve a stationary position of the body during an X-ray examination, it is unlikely that it will be possible to obtain a high-quality image. In such a situation, alternative diagnostic methods should be considered.

How to Prepare for an X-ray of the Lumbar Spine

Radiography of the lumbar and sacral spine needs careful preliminary measures, unlike other parts of the spinal column. Their implementation is necessary in order to obtain high quality and informative images. If you do not follow the rules, the doctor will not be able to reliably evaluate the results of the study, therefore, the patient did it in vain. In this case, a second x-ray is necessary, and this is additional radiation. Therefore, it is better to immediately learn how to prepare for an x-ray when receiving a referral from a doctor. lumbar spine. The specialist will determine the set of necessary procedures.

You can use the following rules:

X-ray machine

You need to start preparing for an X-ray 3 days before the examination.

You should follow a diet that excludes the use of legumes, raw vegetables and fruits, rye bread, sweets, carbonated water, milk. The diet is necessary in order to reduce the formation and accumulation of gases in the intestines, which make it difficult to visualize the spine.

During the next meal, drink a single dose of an enzyme preparation (Creon, Mezim, Pangrol) according to its instructions to improve digestion.

The last meal on the evening before the X-ray is allowed no later than 19 hours. The procedure itself is carried out in the morning on an empty stomach.

12 hours before the proposed study, a cleansing enema is performed in the evening, which is desirable to repeat in the morning.

If it is not possible, a single dose of a laxative (Guttalax, Bisacodyl) should be taken in the evening.

On the day of the procedure, you must stop smoking.

In order to reduce anxiety and muscle tremors, some experts recommend taking sedatives (Valerian extract, Alora, Persen) 3-4 days before taking an x-ray.

Research methodology

The procedure itself is painless and lasts about 10-15 minutes. To begin with, the patient needs to remove all jewelry and metal objects, bare above the waist. The chest, as well as the neck area, is covered with a shielding material in order to reduce the negative effect of radiation on the internal organs.

Important! During the examination, the patient should remain still. This allows you to achieve high quality images and will help the doctor in interpreting the results.

The study is performed when the patient is sitting or lying on the x-ray table. In this position, an x-ray of the lumbar spine is taken in two projections: lateral and direct. In any case, the correct position is determined by the X-ray laboratory technician or radiologist.

Functional radiography of the lumbar spine: how is it done

Sometimes radiography is required using functional tests to assess the mobility of individual segments of the spinal column. A functional type of radiography is performed after a conventional x-ray. The provisions for this may be different. The most commonly used position is on the side with the maximum possible extension and flexion for the patient. You may need to take sitting and standing shots. It is important to accurately and correctly choose the position of the patient and the tilt of the X-ray tube itself.

How X-rays are made for bedridden and elderly patients

Despite the general availability of the method (it can be performed in a clinic with an X-ray room, in a hospital), some patients do not have the opportunity to take an X-ray in a medical institution. In this case, mobile (or portable) devices are used, which are delivered directly to the house, and an X-ray examination is already carried out there. However, the quality of images obtained by this method is inferior to stationary devices.

X-ray results

X-ray study

What the picture shows, only a specialist in the field of radiology can adequately answer, although often a doctor of any specialty is able to draw preliminary conclusions. After the examination, an X-ray image (film) in conventional radiography or a file with an image on an electronic medium in a digital technique is sent to a radiologist. It assesses the state of the bone tissue of the vertebrae, joints of the lumbosacral region, determines the degree of deformation, describes additional education and osteophytes. When x-rays are clearly visualized bone structures, in contrast to ligaments and soft tissues. The patient is given a description of the picture, the conclusion of the doctor. With them, he goes to his treating doctor, who makes the final diagnosis and prescribes treatment.

The safety of the method and the frequency of its implementation

X-rays are absorbed by the tissues and cause photochemical reactions in them, which leads to disruption of the cells. Therefore, there are limitations on the frequency of the survey. For different areas of the body, the radiation exposure is different. So, for radiography of the lumbar spine, the radiation dose is 0.7 mSv with a film technique, and 10 times less with a digital one. The allowable dose is 1 mSv/year, and the maximum dose is 5 mSv.

After a single examination, there will be no direct harm, but if the permissible norms are systematically exceeded, long-term effects are possible: oncological processes, developmental anomalies in the offspring.

Thus, radiography of the spine is a very valuable method for diagnosing diseases of the musculoskeletal system. A qualified specialist will help to correctly interpret the picture. And on the part of the patient, only one thing is needed - high-quality preparation for an x-ray of the spine in the lumbosacral region, which has great importance for an accurate assessment of the result of the study.

Do you often experience back or joint pain?

Do you have a sedentary lifestyle? You cannot boast of a royal posture and try to hide your stoop under your clothes? It seems to you that this will soon pass by itself, but the pain only intensifies ... Many methods have been tried, but nothing helps ... And now you are ready to use any opportunity that will give you the long-awaited good health!

According to WHO, up to 90% of people have experienced back pain at least once. Moreover, this symptom is most often observed in patients older than 60 years (up to 50% of cases). The causes of pain in the back are varied. In addition to organ pathology abdominal cavity these include diseases of the vertebrae, intervertebral discs, ligaments and muscles, spinal cord and spinal nerves. A simple method to help diagnose diseases and injuries of the spine is an x-ray of the lower back.

Doctor examining an x-ray

At this study the vertebrae are well visualized, however, the state of other structures (intervertebral discs, ligaments) can only be judged by indirect signs. Soft tissue formations are invisible on X-ray. However, in cases of ossification or deposition of calcium salts, it is X-ray of the lumbar spine that can show pathologically altered discs and ligaments. With the introduction of a contrast agent under the arachnoid (myelography), it becomes possible to examine the spinal cord, assess the patency of the subarachnoid space.

Who needs an x-ray?

Radiography of the lumbosacral spine is prescribed for suspected injuries and diseases. The following indications for research are distinguished:

Lower back pain not associated with pathology internal organs. Crawling sensation (paresthesia) or numbness lower extremities. Restriction of movements in the lumbar spine. Curvature of the spinal column.

Pain in the lumbar spine

X-ray allows you to diagnose lesions, tumors, degenerative, inflammatory and infectious diseases spine. However, the study of discs, ligamentous apparatus, muscles, spinal cord requires the involvement of other, more informative methods. Fluoroscopy cannot show lesions seen on CT or MRI. Nevertheless, X-ray, as the most accessible method, is widely used in the diagnosis of pathology of the lumbosacral spine. Within the framework of compulsory medical insurance, the study is carried out free of charge as prescribed by the attending physician. Additional diagnostic procedures are usually performed at the expense of the patient, which means that they are not available to all categories of the population.

Contraindications for the study

X-ray of the lumbar spine is highly undesirable during pregnancy. Unlike images of other areas of the body, in this case it is not always possible to shield the embryo from radiation. This is especially true for the study of the sacrococcygeal department.

X-rays in the third trimester are less dangerous for the fetus. However, only the lateral projection provides useful information at this time. In the direct projection picture, the child's skeleton is superimposed on the mother's spine, making diagnosis much more difficult. Therefore, pregnant women usually do not have an x-ray of the lumbosacral region. In case of emergency (suspected injury or tumor), you can resort to a study that is not accompanied by radiation - MRI.

Magnetic resonance imaging does not carry radiation exposure

An x-ray of the lower parts of the spinal column is associated with a high risk of exposure to the genital organs, so the study is extremely dangerous for pregnant women. A snapshot of the lumbosacral region is best done in the first 10-14 days after the end of menstruation. This precaution prevents accidental irradiation of the embryo if the patient is not yet aware of her pregnancy.

Study preparation

The lower part of the spinal column is adjacent to the distal intestine. Gas formation in this organ greatly complicates the diagnosis. For this reason, proper preparation for an x-ray of the lumbosacral spine is extremely important for obtaining a high-quality image:

2-3 days before the procedure, it is necessary to refrain from eating foods that increase gas formation: beans, beans, cabbage, black bread, apples. The study should be carried out on an empty stomach. The last meal on the eve before the x-ray should be no later than 18:00. A cleansing enema is performed in the evening and in the morning before the study.

Esmarch's irrigator

X-ray of the lumbar spine also implies some additional conditions that increase the information content of the image. Preparation also includes emptying Bladder before the procedure and removal of metal objects from the area of ​​the body being examined. The latter block X-rays and form additional shadows in the picture.

The informativeness of the X-ray examination of the lumbar region strongly depends on the quality of the preparation. Not every patient is aware of this. Therefore, the doctor who sent the patient for examination must necessarily explain how to prepare for an x-ray of the lumbar spine.

Research technique

When performing X-rays of the lumbar spine, the following projections are used:

Direct (front and back). Lateral. Oblique (left and right, back and front).

The picture can be taken in a prone or standing position. The upright position is usually used to diagnose curvature of the spine. To study the mobility of the lumbar region, to identify the displacement of the vertebrae, functional tests are prescribed:

Pictures in the lateral projection are taken during flexion and extension in the lumbar region. In a direct projection, it is possible to assess the mobility of the spinal column when tilted to the side - to the left and to the right.

Radiographs of the lumbar spine in lateral and direct projection

How is an x-ray taken in the supine position? For better visualization of the structures of the spine, it is important to know some features of the patient's position:

In the supine position for the study of the lumbar region, the patient's legs should be bent at the knees. At the same time, the physiological curvature of the spine (lordosis) is straightened, and the spinal column itself is located close to the cassette and parallel to it, increasing the quality and information content of the image. When examining the sacrum and coccyx, this condition is not mandatory; in this case, the image is taken with the legs extended. In order to achieve parallel to the cassette arrangement of the spine in the lateral projection, a radiolucent pillow is placed under the patient's waist area.

Much attention is paid to the protection of the genital organs from radiation. When taking a picture of the lumbosacral region, special plates that do not transmit x-rays should be used. However, their use is not always possible. If the screen covers the area of ​​interest to the doctor (for example, when taking a picture of the sacrococcygeal region), it will have to be abandoned, otherwise the meaning of the study is lost.

Radiation load during radiography of the lumbar vertebrae is 0.7 and 0.08 mSv when the image is taken with a film and digital device, respectively.

Result interpretation

What does an x-ray of the lumbosacral spine show:

Developmental anomalies: additional vertebrae, changes in the shape of their bodies and processes. Injuries. X-ray shows fracture lines, displacement of fragments. With a compression fracture, the vertebra takes the form of a wedge, its height decreases. Osteochondrosis. It is characterized by a decrease in the height of the intervertebral gap, the destruction of the end plates, the appearance of marginal bone growths. Another sign is a violation of the stability of the affected disc, which is shown by an x-ray with functional tests. When moving, a greater (hypermobility) or lesser (hypomobility) convergence of the vertebrae of the affected segment is determined than is observed in neighboring healthy parts of the spinal column. With instability, the vertebrae are displaced anteriorly, posteriorly, or to the side by more than 2 mm. Deforming spondylosis. Pathology occurs due to ossification in the anterior longitudinal ligament. X-rays show coracoid bone growths extending from the anterior and lateral surfaces of the vertebral bodies. The structure of the vertebrae themselves, as well as the height of the intervertebral fissure, is not disturbed. In the case of spondylosis, the anterior longitudinal ligament is changed over 2-3 vertebrae. Its defeat over a larger area is called Forestier's disease (fixing ligamentosis). Arthrosis of the intervertebral joints (spondylarthrosis). Radiologically, it is manifested by a narrowing of the joint space, the appearance of bone growths, sclerotic changes in the structures involved in the formation of the joint. Disc herniation. It is extremely difficult to determine this pathology on an x-ray. Signs of a hernia - straightening of lordosis, scoliosis (pathological curvature), wedge-shaped form of the intervertebral gap (symptom of "strut") - are not always visible. The method of choice for diagnosing disc pathology is MRI.

Hernia intervertebral disc on MRI

Tuberculous spondylitis. The intervertebral gap in the affected area narrows, local osteoporosis is noted in the vertebral body, caverns and marginal destruction appear. Possible wedge-shaped deformity of the vertebra. Tumors on x-rays are visible if they reach large sizes and destroy the structures of the spinal column. Small lesions may not show up on x-rays.

X-ray allows you to well visualize the pathology of the vertebrae. However, diseases of other formations - ligaments, discs, spinal nerve roots, spinal cord - can be extremely difficult to detect in the picture. Therefore, to clarify the diagnosis, one has to resort to more informative methods - CT and MRI.

Other ways to diagnose diseases of the spine

X-ray with contrast (myelography or pneumomyelography) allows you to examine the structures of the spinal canal that are invisible in a conventional picture. However, with the introduction of such diagnostic procedure like an MRI, there is no need to apply contrast. Magnetic resonance imaging is a method indicated for the study of the spinal cord and subarachnoid space. MRI has proven itself in the diagnosis of intramedullary tumors, herniated discs, and traumatic spinal cord injuries.

MRI of the lumbosacral spine

CT is superior to X-ray in terms of information content. This study helps to assess the condition of not only the vertebrae, but also other structures: ligaments, muscles, discs. However, visualization of vessels or neoplasms of the spinal cord, as with radiography, sometimes requires the introduction of contrast, which is accompanied by the risk side effects. The disadvantage of the method is the radiation exposure of 5.4 mSv per procedure, which makes it impossible for pregnant women to conduct the study.

Another radiological method used in the diagnosis of pathology of the lumbar vertebrae is a radionuclide study. A radiopharmaceutical is introduced into the patient's body - a substance containing a radionuclide in its composition. The radiation emitted by the latter is recorded by diagnostic devices, allowing to assess the accumulation of the drug in the structures of the spinal column. The method is used to detect tumors, primary and metastatic, as well as to diagnose inflammatory diseases spine.

To date, X-ray of the lumbosacral spine is the most informative method for diagnosing various pathologies and diseases. The procedure is quick, painless, and the new medical equipment uses a minimal dose of dangerous X-rays.

X-rays can be performed in any medical institution: in the clinic at the place of residence, in the surgical department of the hospital or in a private clinic.

Diagnostics is also carried out outside the medical institution using mobile devices.

Why do you need to do an X-ray of the lower back?

The main indication for diagnosis is pain in the lumbar region.. If a course of therapy aimed at eliminating pain, ineffective, a referral for radiography is issued.

X-rays are also shown for:

pain in the back and extremities; numbness of the extremities; curvature of the spine; suspicion of malignant tumors; suspicion of protrusion; vertebral hernia; chronic fatigue and weakness; complications after fractures; diagnosis preceding surgical operation or after surgery.

Note: the main drawback of diagnostics is the difficult examination of muscles and ligaments, as well as the impossibility of examining soft tissues. X-rays cannot diagnose sprains.

What does an X-ray of the lumbosacral spine show?

During radiography, a specialist evaluates the structure of the bone tissue of the vertebrae, diagnoses the presence of fluid and possible deformations of the intervertebral discs. In addition, various pathologies of the spinal column are revealed.

Radiography is effective for diagnosing:

pathological bending of the spine; painful wear and tear of bones and cartilage; cancerous tumors; osteoporosis - pathological thinning of bone tissue; spondylolisthesis - displacement of the vertebrae in relation to other vertebrae; sciatica; stenosis - narrowing of the spine; diseases of the spine of an infectious nature; herniated disc ..

Note: the pathologies that are diagnosed during the x-ray of the lumbar spine are not always caused by problems in the back.

How to prepare for the procedure

Unlike x-rays of the cervical region, x-rays of the lumbosacral region require quite serious preparation. The preparatory process begins three days before the date of the diagnosis.

The doctor who issues the referral for the examination must tell in detail about all the preparatory measures that the patient must perform.

If you do not properly prepare for an x-ray, the pictures will turn out to be fuzzy, blurry, which makes it much more difficult to establish a correct diagnosis and suggest an appropriate course of therapy.

Stages of preparation

A few days before the examination, the patient should exclude from his diet products that contribute to increased flatulence: milk, fresh fruits and vegetables, legumes, black bread. Take Activated carbon three times a day, two tablets. As a sedative, the patient must take valerian root three times a day, 15 drops. This will allow you to feel calmer during the procedure and remain still. The last meal on the eve of the examination no later than 19 hours. Two enemas are prescribed: the night before and on the day of the diagnosis. On the day of the x-ray, the patient should not drink, eat and smoke.

Why are preparations necessary?

First of all, all preparatory measures are aimed at cleansing the intestines, since an excess amount of gases and stool make research much more difficult.

Poor-quality images will not make it possible to make a correct diagnosis, a re-examination will be required, and, consequently, an additional dose of X-ray exposure.

How is the survey done

The procedure is performed quickly enough and does not cause discomfort. The only unpleasant sensation during the x-ray can be a cold table.

The patient removes clothes from the upper part of the body, clothes and jewelry and takes a fixed position (sitting or lying down) on the x-ray table. To protect the body, the neck and chest are covered with a shielding plate.

The required number of shots is taken within a quarter of an hour.

X-ray with functional tests

Functional radiography is relevant for the study of the most mobile areas of the spinal column: the cervical and lumbar.

In this case, the diagnosis is carried out in a lateral projection, when the patient lies, with the maximum possible flexion and extension. The most informative and visual is radiography, which is carried out in a position in an upright position or sitting.

However, the technical capabilities of the medical institution and physical state patient is not always allowed to use this method diagnosis of pathologies of the spine.

To make the study as complete as possible, radiographs in three projections are needed:

one rear; two lateral: during flexion and maximum extension.

Functional tests are strictly individual for each clinical picture. The main condition for sampling is the opposite directions of body position. This is the only way to determine the full volume of movements in the selected segment. It is also important to choose the correct angle of the X-ray tube to avoid possible distortion of the image in the pictures.

Note: all necessary studies of the lumbar spine with functional tests can be performed in a conventional x-ray room.

X-ray photo of the lumbar spine with functional tests

Functional radiography is performed based on the results of the classic X-ray of the lumbar spine and general condition patient.

The areas of the spinal column are selected that require additional and more thorough examination. Then the specialist chooses the optimal diagnostic technique.

The following tests are used for functional diagnostics of the spine:

In the supine position. Flexion. The patient lies on his side, puts his head on the arm bent at the elbow, bends the legs at the knees and pulls them to the stomach. Extension. The patient stands sideways to a vertical base, maintaining a lumbar lordosis position. One arm is bent at the joint and is behind the head. The second hand touches the edge of the table. In a sitting position. Flexion. The patient sits sideways to the vertical base, touching it with his body. Hands are crossed, clasping the knees, while the elbows rest on the hips. The torso must be tilted forward as much as possible. Extension. The patient needs to bend back as much as possible, tilt his head and arch his chest. In a standing position. Flexion. The patient stands sideways to the vertical base, touching it with the body. Performs the maximum possible forward lean, touching the floor with your hands and without bending your knees. Extension. The patient stands sideways to the vertical base, bends as much as possible, throws back his head and clasps his hands in a lock at the back of his head.

Functional diagnostics of the spine is carried out in patients with acute pain who are in the hospital. To do this, the patient lies on the laterographic attachment, the hips and upper body should touch the base. After the legs are bent at the knees and pressed to the stomach.

Price

The advantage of the survey lies in the affordable cost.

In paid clinics, the cost of diagnostics ranges from 450 to 2200 rubles, and functional diagnostics - from 800 to 3000 rubles. In state medical institutions examinations can be carried out free of charge.

The cost of the examination depends on the complexity of the disease, the equipment used, the city where the patient lives, and the status of the clinic.

Note: in large settlements, you can use the services of a mobile X-ray machine, which specialists deliver to the patient's place of residence and conduct an examination at home. However, it is important to bear in mind that under such conditions, the quality of the images is somewhat lower than in the clinic.

Contraindications

pregnant and lactating mothers; children; excessive nervous excitement; overweight; previous radiography using barium suspension.

Despite the fact that, today, spinal radiography is not the only method for diagnosing pathologies of the spinal column, this technique is the most reliable and informative.

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1. Determination of pain along the spinous processes of the spine and at paravertebral points.

2. Symptom Zatsepin - pain when pressed at the point of attachment to the vertebrae of the X-XII ribs due to the inflammatory process in the costovertebral joints.

3. Vereshchakovsky's test - to detect tension in the muscles of the abdomen and back. The patient stands with his back to the doctor, the doctor puts his hands palms down on the iliac crests and, gradually pressing, tries to go deep into the gap between the costal margin and the iliac crest. In the presence of inflammatory process in the rectus dorsi muscles, the hands encounter sharp resistance from the muscles of the abdomen and back.

4. Symptom Forestier - to determine the form of posture. The patient stands with his back to the wall, touching it with his heels, torso, head. Normally, the heels, shoulder blades, and back of the head should touch the wall. In patients with ankylosing spondylitis and Forestier's disease, due to the development of kyphosis, there will be no contact at any point.

5. Determination of mobility in the cervical spine. From CVII measure up 8 cm and make a mark. Then they ask the patient to tilt his head down as much as possible and measure this distance again. In healthy individuals, it increases by 3 cm. If the cervical spine is affected, this distance increases slightly or does not change at all. In patients with ankylosing spondylitis, with a short neck, the test is not informative.

6. Test chin - sternum: a healthy person freely touches the chin to the sternum. When the cervical spine is affected, the distance between the chin and the sternum remains with the maximum tilt of the head forward.

7. Ott test - to determine mobility in the thoracic spine. 30 cm are measured from Suts down and a mark is made. Then the distance between the indicated points is measured again with the maximum inclination of the subject forward. In healthy people, this distance increases by 4-5 cm, and in patients with ankylosing spondylitis, it practically does not change.

8. Determining the restriction of respiratory excursions chest- to identify the pathological process in the costovertebral joints. The measurement is made with a centimeter tape at the level of the IV rib. Normally, the difference in the circumference of the chest between the maximum inhalation and exhalation is 6-8 cm. With the development of ankylosis of the costovertebral joints, this difference decreases to 1-2 cm. In the presence of emphysema, the test is not informative.

9. Schober's test - to detect limited mobility in the lumbar spine. From Ly lay 10 cm upwards and make a mark. With a maximum forward inclination in healthy individuals, this distance increases by 4-5 cm, and with damage to the lumbar spine, it practically does not change.

10. Thomayer test - to assess the overall mobility of the spine. It is determined by measuring in centimeters the distance from the third finger of outstretched hands to the floor with a maximum forward inclination. This distance is normally equal to "0" and increases with restriction of flexion of the spine.

11. Vertebral index (PI). To determine it, the following values ​​\u200b\u200bare added (in cm): the distance chin - jugular notch of the sternum with a maximum deviation of the head back, Ott test, Schober test, respiratory excursion of the chest. From the amount received, the Thomayer test indicator (in cm) is subtracted. The value of PI in the norm averages 27-30 cm (individually) and is evaluated in dynamics. A decrease in PI indicates progression of spinal mobility limitation.

Symptoms for detecting sacroiliitis

2. Symptom of Kushelevsky (II): the patient lies on his side, the doctor puts his hands on the iliac bone and presses on it with a jerk. The patient at the same time feels pain in the sacrum.

3. Symptom Kushelevsky (III): the patient lies on his back, one leg is bent at the knee joint and laid aside. The doctor rests with one hand on this knee-joint, and with the other hand presses on the opposite ilium. The patient feels pain in the area of ​​the SIJ. Then the presence of pain in the area of ​​another SIJ is checked.

4. Makarov's symptom (I) - is characterized by the occurrence of pain when tapping with a diagnostic hammer in the area of ​​the SIJ.

5. Makarov's symptom (II): the patient lies on his back, the doctor grabs his legs above the GSS, forcing him to relax the muscles of the legs, and then jerks his legs apart and brings them together. There are pains in the sacroiliac region.