Diagnostic Technology for Spine Pathology

Abstract

Diagnostic techniques for spinal pathologies have been developed in accordance with advances in technology. Accurate diagnosis of spinal pathology is essential for appropriate management of spinal diseases. Since the development of X-rays in 1895 and computed tomography (CT) in 1967, several diagnostic imaging modalities have been utilized for detecting spinal pathologies, including radiography, CT, magnetic resonance imaging, and radionuclide imaging. In addition to diagnostic imaging technologies, electrodiagnostic tests, including electromyography and nerve conduction studies, play a significant role as diagnostic tools, as spinal diseases are mostly profoundly associated with pathologies of the neural structures, such as the spinal cord and nerve root, and extent of injury at the structure cannot be adequately detected by conventional imaging techniques. In patient-specific treatment strategies, usage of diagnostic modalities is of great importance; thus, we should be aware of the basic details and approaches of the different diagnostic modalities. In this review, the authors discuss the details of the technologies that aid in the diagnosis of spinal pathologies.

Keywords: Diagnosis; Electrodiagnostic study; Images; Spinal diseases.

Fig. 1.

Three-dimensional computed tomography images for preoperative planning. (A) Bilateral vertebral arteries with normal course were observed. (B) Right unilateral vertebral artery without left vertebral artery was detected.

Fig. 2.

A 63-year-old female patient with degenerative cervical myelopathy. (A) Neutral sagittal magnetic resonance (MR) imaging of the cervical spine showed a C4–5 canal stenosis with signal change of the spinal cord. (B) Extension sagittal MR of the cervical spine showed more aggravated cord compression of C4–5 segment, as well as the cranial and caudal extension of the cervical canal stenosis to C3–7 levels.

Fig. 3.

A 75-year-old male patient was admitted to the emergency room with lower motor weakness and sensory change that gradually developed and was diagnosed with T7–9 epidural space mass lesion and prostate cancer multiple metastasis. (A) A preoperative whole-body bone scan showed hot-uptake of the skull, mandible, multiple ribs, T7–11, and L4–5, suggesting metastasis. (B) In the preoperative enhanced magnetic resonance image, metastasis was confirmed in the T5, T7, and L3 vertebral bodies, and T7–9 cord compression was seen.

Fig. 4.

Assessment of central motor conduction time (A) and sensory evoked potential (B).