Learn how spinal cord examination and imaging diagnose disorders. Explore MRI, CT scans, and EMG testing used to evaluate spinal health.
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Diagnosis and Imaging
Diagnosing a spinal cord disorder is a multi step process. It begins with a careful medical history and physical examination. The doctor needs to understand exactly where the symptoms are located and how they started. This clinical picture guides the choice of diagnostic tests.
Since the spinal cord is hidden inside the bone, doctors rely heavily on advanced imaging to see what is happening. The goal is to determine if the problem is in the bone, the soft tissue, the nerves, or the cord itself. Accurate diagnosis is essential for planning surgery or treatment.
A spinal cord examination is a specialized neurological assessment. The doctor systematically tests the function of the spinal cord from top to bottom. They use the concept of dermatomes (skin areas) and myotomes (muscle groups) to map the injury.
The exam evaluates:
During the exam, you will be asked to move your arms and legs against resistance. The doctor will touch different parts of your body with a pin or cotton swab and ask if you can feel it. They will use a reflex hammer on your knees, ankles, and elbows.
Specific tests include:
Magnetic Resonance Imaging (MRI) is the gold standard for imaging the spinal cord. It uses powerful magnets and radio waves to create detailed images. Unlike X rays, an MRI can see soft tissues clearly.
MRI capabilities:
Computerized Tomography (CT) scans use X rays to create cross sectional images of the body. While an MRI is better for the cord, a CT scan is superior for looking at the bones. It is often the first test done in an emergency setting.
CT usage:
Myelography involves injecting a contrast dye into the spinal canal using a needle. After the dye is injected, X rays or CT scans are taken. The dye outlines the spinal cord and nerve roots, making them show up clearly.
This test is used when:
Electromyography (EMG) assesses the health of muscles and the nerve cells that control them. This test tells the doctor if the weakness is caused by the muscle itself or by the nerve supplying it. It is often done alongside a nerve conduction study.
The procedure involves:
SSEP tests measure the electrical signals sent from the body to the brain. Small electrodes are placed on the scalp and spine. An electrical pulse is delivered to the arm or leg. The machine measures how long it takes for the signal to reach the brain.
This test is useful for:
A lumbar puncture, also known as a spinal tap, involves inserting a needle into the lower back to collect cerebrospinal fluid. This fluid surrounds the brain and spinal cord. Analyzing this fluid provides clues about infections and inflammation.
It helps diagnose:
For some non traumatic spinal cord disorders, genetic testing is necessary. Conditions like Hereditary Spastic Paraplegia or Spinal Muscular Atrophy are caused by gene mutations. A blood test can confirm these diagnoses.
Testing benefits:
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X-rays only show bones; they cannot show the spinal cord, discs, or nerves. You can have a severe spinal cord injury even if the bones look normal on an X-ray.
A high signal (white spot) on a T2 weighted MRI usually indicates swelling (edema) or scarring (myelomalacia) inside the spinal cord, which is a sign of injury or disease.
The procedure involves a spinal tap to inject dye, which can cause some pressure and a headache afterwards, but the scan itself is painless.
While tests like DTI and MEPs provide information about how many nerve connections are left, they cannot predict recovery with 100% certainty; clinical improvement over time is the best indicator.
Oligoclonal bands are proteins found in the spinal fluid that indicate inflammation in the central nervous system; finding them suggests a diagnosis of Multiple Sclerosis.
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