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Spinal Cord Diagnosis and Imaging

Spinal Cord Diagnosis and Imaging focused on advanced neurological assessment and high resolution imaging to accurately identify injuries and guide treatment decisions

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

How Is Spinal Cord Disorder Diagnosed?

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.

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What is a Spinal Cord Examination?

Magnetic Resonance Imaging (MRI)

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:

  • Mental status to rule out brain injury
  • Cranial nerves to ensure the brainstem is working
  • Motor system for strength and tone
  • Sensory system for pain and touch perception
  • Reflexes to check for cord compression signs
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What Happens During the Exam?

Spinal Cord

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:

  • Babinski sign test stroking the foot bottom
  • Hoffmann’s sign test flicking the middle finger
  • Romberg test checking balance with eyes closed
  • Gait analysis watching how you walk
  • Rectal exam to check for sensation and tone in emergencies

MRI Scans

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:

  • Visualizes the spinal cord itself and nerve roots
  • Shows herniated discs and ligament damage
  • Detects tumors and infection within the cord
  • Identifies fluid accumulation or cysts
  • reveals bruising or swelling after trauma

CT Scans

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:

  • Detects fractures or broken vertebrae quickly
  • Shows bone spurs or osteophytes
  • Used when a patient cannot have an MRI due to metal implants
  • Provides a detailed view of the bony spinal canal
  • Helps plan surgical screw placement

Myelography

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:

  • MRI is not an option for the patient
  • Dynamic nerve compression needs to be seen
  • Doctors need to see if cerebrospinal fluid is leaking
  • Detailed nerve root anatomy is required before surgery
  • Arachnoiditis or scarring is suspected
Spinal Cord

Electromyography EMG

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:

  • Inserting fine needles into specific muscles
  • Measuring electrical activity at rest and contraction
  • Determining if nerve damage is acute or chronic
  • Localizing the specific nerve root involved
  • Differentiating between peripheral nerve and spinal cord issues

Somatosensory Evoked Potentials SSEP

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:

  • Assessing the function of the spinal cord pathways
  • Monitoring the spinal cord during surgery
  • Diagnosing multiple sclerosis
  • Evaluating patients who cannot communicate
  • Checking sensory pathway integrity

Lumbar Puncture

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:

  • Meningitis of spinal cord
  • Multiple sclerosis via oligoclonal bands
  • Guillain Barre syndrome
  • Cancers that have spread to the spinal fluid
  • Bleeding around the brain or cord

Genetic Testing

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:

  • Confirms diagnosis in hereditary conditions
  • Helps with family planning and counseling
  • Predicts the likely progression of the disease
  • Identifies eligibility for gene therapies
  • Rules out other treatable metabolic causes

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FREQUENTLY ASKED QUESTIONS

Why do I need an MRI if the X-ray was fine?

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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