MRT of the thoracic spine

If the symptoms of a patient’s complaints cannot be localized precisely, an MRI examination of the thoracic spine may also be indicated. The principle is the same as for the MRI examination of the cervical spine. To examine the thoracic spine, the patient must at least completely undress the upper body and remove all metal-containing objects.

Patients with pacemakers are generally not allowed to have an MRI examination! The patient lies on a mobile couch which is pushed into the tube for the examination. A frequent indication for an MRI examination of the thoracic spine is the suspicion of a slipped disc.

Although a herniated disc in the thoracic spine is rather rare (a large proportion of herniated discs are located in the lumbar spine), it should be ruled out in cases of severe back or chest pain in the corresponding area. The spinal cord or intervertebral discs, as soft tissue, can be assessed very accurately in an MRI of the thoracic spine, whereas the vertebral bodies, as bony structures, are better visualized in a conventional X-ray or CT.Tumors in the spinal cord area often have similar symptoms to a herniated disc and can also be diagnosed with a nuclear spin examination. Metastases in the bone marrow (e.g. after breast cancer) can also be visualized by MRI. An inflammation of the intervertebral disc space (spondylodiscitis) as soft tissue is also visible in the MRI. After a whiplash injury (e.g. due to a car accident), injuries to the spinal cord of the thoracic spine or bleeding in the area of the thoracic spine can be excluded in the MRI.

MRI of the cervical spine in multiple sclerosis (MS)

Patients suffering from multiple sclerosis (MS) should receive MRI scans of the cervical spine and MRI scans of the thoracic spine at regular intervals. Multiple sclerosis is a chronic inflammatory disease of the central nervous system (which includes the brain and spinal cord) that attacks the medullary sheaths around the nerves. These so-called demyelinating foci are located in the spinal cord as well as in the brain and can be shown in the sectional images of the MRI.

Gadolinium-containing contrast media can be used to detect fresh foci. In contrast to intact tissue, the blood–brain barrier in the area of acute lesions is permeable to the contrast medium, so that the demyelination foci can be detected by MRI. If a multiple sclerosis patient suffers loss of arms or legs or bladder voiding problems, the demyelination foci in the cervical or thoracic spine can be suspected and can be visualized with an MRI examination.

In order to distinguish old MS foci from new ones, it is recommended to administer a contrast medium during the MRI examination. Slipped discs (prolapsus nuclei pulposi) in the cervical spine are a rarity, accounting for about 15% of all slipped discs. On the one hand, the cervical spine carries much less weight than the lumbar spine, for example, and on the other hand, it performs far less powerful movements than the latter.

Chronic herniated discs of the cervical spine due to permanent bad posture are more frequent than acute herniated discs, which can be caused by jerky head turning. In a herniated disc, the inner gelatinous core (nucleus pulposus) of the intervertebral disc (discus intervertebralis) passes through the outer fibrous ring (annulus fibrosus). The reason for this can be wear and tear or, more rarely, an injury.

The so-called spinal nerves, which emerge from the spinal cord and are thus immediately adjacent, are irritated by the emerging nucleus of the intervertebral disc and the affected person feels a strong, stabbing pain along the nerve tracts. In the case of a herniated disc in the lower neck, the pain often radiates into the fingertips, since the irritated nerve supplies the arm. Numbness can also occur.

If the intervertebral disc presses directly on the spinal cord, a cross-sectional symptomatology can develop, which is relatively dramatic in the area of the cervical spine, since the nerve tracts responsible for breathing can be impaired. After questioning and physical or neurological examination by the doctor, the diagnosis must be confirmed by imaging. Magnetic resonance imaging of the cervical spine is the method of choice here because it depicts soft tissue structures such as intervertebral discs, spinal cord or nerve roots much better than x-rays or CT.

In the MRI, the herniated disc of the cervical spine can be precisely located and the direction in which the disc has advanced can be determined. The administration of a contrast medium is usually not necessary to diagnose or exclude a herniated disc of the cervical spine. If a herniated disc of the cervical spine causes only pain and movement restrictions, but no reduction in strength or neurological symptoms, then treatment should initially be conservative.

In the majority of patients, after the administration of painkillers, anti-inflammatory and muscle-relaxing drugs, as well as immobilization and, later, physiotherapy, no surgical intervention is necessary. If conservative therapy fails or immediately in case of muscle weakness or neurological symptoms, surgery is performed. First, the leaked disc tissue is surgically removed. As a therapy option, a stiffening of the adjacent vertebral bodies (spondylodesis) or the use of an artificial disc are then available.