What is an MRI?

An MRI (Magnetic Resonance Imaging) scan uses magnets and radio waves to capture images inside your body without making a surgical incision. The scan allows your doctor to see the soft tissue of your body, like muscles and organs, in addition to your bones.

An MRI can be performed on any part of your body. A lumbar MRI specifically examines the lumbar section of your spine — the region where back problems commonly originate. Similarly, cervical spine MRI covers the neck part of your spine and Thoracic spine covers the chest part of spine.

Why an MRI is done?

An MRI scan provides a different kind of image from other imaging tests like X-rays (which is most of the times a preliminary screening tool for spinal conditions) or CT scans (Which give more detail about the bones and joints). An MRI of the spine shows the bones, disks, spinal cord, nerves, muscles and the spaces between the vertebral bones where nerves pass through.

Your spine surgeon may recommend an MRI to better diagnose or treat problems with your spine. Injury-related pain, disease, infection, or other factors could be causing your condition. Your doctor might order a lumbar MRI if you have the following symptoms:

back pain or neck pain accompanied by fever

birth defects affecting your spine

injury to your spine

persistent or severe neck pain or back pain

multiple sclerosis

problems with your bladder or toilet functions

weakness, numbness, or other problems with your legs

rarely signs of spinal cancer

Your spine surgeon might also order an MRI if you’re scheduled for spinal surgery. The MRI will help them plan the procedure before making an incision.

How to prepare for a lumbar MRI

Before the test, tell your doctor if you have a pacemaker. Your doctor may suggest another method for inspecting your lumbar spine, such as a CT scan, depending on the type of pacemaker. But some pacemaker models can be reprogrammed before an MRI so they’re not disrupted during the scan. This can be done by your spine surgeon in co-ordination with your heart doctor. The MRI technician will ask you to remove all jewellery and piercings and change into a hospital gown before the scan. An MRI uses magnets that can sometimes attract metals. Be sure to tell your doctor if you have any metal implants or if any of the following items are present in your body which h might include (but not limited to): artificial heart valves, clips, implants, pins, plates, prosthetic joints or limbs, screws, staples or stents.

If a contrast is required for your MRI (in conditions like history of previous surgery, suspicion of infection or cancer etc), tell your spine surgeon about any allergies you have or allergic reactions you’ve had.

What to do if the patient is Claustrophobic?

If you’re claustrophobic, you may feel uncomfortable while in the MRI machine. Tell your doctor about this so they can prescribe anti-anxiety medications. In some cases, you can also be sedated during the scan. Or recently we have option of open MRI.

What are the risks of a MRI scan?

Unlike an X-ray or CT scan, an MRI doesn’t use ionizing radiation. It’s considered a safer alternative, especially for pregnant women and growing children. To date, here have been no documented side effects from the radio waves and magnets used in the scan.

There are risks for people who have implants containing metal. The magnets used in an MRI can result in problems with pacemakers or cause implanted screws or pins to shift in your body.

Another complication is an allergic reaction to contrast dye Allergic reactions to the dye are often mild and easy to control with medication. But, sometimes anaphylactic reactions (and even deaths) can occur.

How an MRI is performed?

An MRI scanner looks like a usually has a doughnut like central part with a bench that slowly glides you into the central part. If you follow all the instructions of the technician and removed all metal items before entering, the MRI machine is a very safe place to be.  The entire process can take from 30 to 90 minutes. The technician will have you lie on the bench with a pillow and a blanket. The technician will control the movement of the bench from another room. They can communicate with patient through a speaker. During the MRI the machine makes some loud humming and thumping noises as it takes the images. Many hospitals offer Ear muffs or plugs to shield from the noise. As the images are being taken, the technician will ask you to hold your breath for a few seconds. You won’t feel anything during the test. If contrast dye will be used, a nurse or doctor will inject the contrast dye through a tube inserted into one of your veins. In some cases, you may need to wait up to an hour for the dye to work its way through your bloodstream and into your spine.

After an MRI

After the test if you took sedatives before the procedure, you shouldn’t drive otherwise there are no special precautions. It would be best to let your spine surgeon have a look at the report and make the required conclusions for you rather than googling your report findings.

Spine surgery has become very safe now due to the wide spread availabiltiy and opportunities for training like spine fellowships,observerships, cadveric workshops, conferences etc. Spine surgery has also become more safer than before, due to the availablity of advanced imaging which helps in better planning and execution of surgeries and due to advances in anasthesia and neuromonitoring facilities which are widely available a cheaper price now. Neverthless, all surgeries have some inherent risks.( There is no surgery with zero risk). It is important to discuss with your doctor what he/she feels the overall chances of a particular complication are in your condition.Spinal cord and spinal nerves are more sensitive when compared to other tissues. Delay in diagnosis with continued pressure can add to the chances of complications particularly in conditions like Cancer, infections( like tb), high speed collision accidents etc. Earlier the surgery is done during the disease process lesser the chances of complications. It is best to visit a spine specialist and get neccesary evaluation earlier then later.

All surgery has inherent risks. Certainly, spinal surgery has its own set of risks which may include infection, pain at the incision site, lack of fusion, as well as neurologic complications. However, with well-trained hands, the incidence of complications differs very little than from other surgical conditions. It is important to discuss with your doctor what he feels the overall chances of a particular complication are in your given setting.

Potential Complications of Surgery

You should discuss the complications associated with surgery with your Spine specialist before surgery. The list of complications provided here is not intended to be complete and is not a substitute for discussing the risks of surgery with your Spine specialist. Only your Spine specialist can evaluate your condition and inform you of the risks of any treatment that may be recommended.

Anaesthesia — Any surgery that requires anaesthesia can be potentially harmful. Surgery on the cervical spine usually requires that you be put under general anaesthesia. General anaesthesia means that you are put to sleep. Anaesthesia carries a risk of allergies to the medications. There are also different life-threatening situations that can occur during anaesthesia. It is extremely unlikely that these complications will occur, but you should be aware that they are possible.

Infection — Any surgery involving an incision in the skin can become infected. In addition, the bone graft and area around the spine may become infected. An infection will usually require some type of antibiotic medication to treat the infection. If the infection involves the bone, it may require one or more additional surgeries to drain the infection. The risk of infection is usually less than one percent.

Blood Vessel Damage — There are large arteries and veins that travel through the neck into the brain. The carotid artery and the jugular vein are nearby. It is possible to damage these blood vessels during the surgery. Again, it is extremely unlikely that this will occur, probably less than one in a thousand.

Nerve Damage — There are nerves in the neck that travel along the area where the incision is made to perform an anterior cervical discectomy and fusion. These nerves go to the vocal chords. There is the possibility that these nerves can be damaged during surgery. This can lead to hoarseness. If this occurs, the nerves will usually recover unless they are permanently damaged or cut. Again, this is unlikely.

Spinal Cord Damage — Surgeries that are performed on the cervical spine place the spinal cord at risk for injury. Spinal cord damage is probably much more likely in the larger, more serious operations such as the corpectomy and strut grafting procedures. These are complex, difficult operations and are done for extremely serious problems that are unlikely to respond to any other type of treatment. Routine anterior discectomy and fusion are common surgeries that are extremely safe. While damage to the spinal cord is possible, it is highly unlikely.

Graft Displacement — One of the more common problems that can occur after an anterior cervical discectomy and fusion is that the bone graft may move out of position. If it moves too much, it may require a second surgery to place a new bone graft in its place.

Non-Union — In spite of a successful surgery and good bone graft, a fusion may not occur between the vertebrae. This is termed a non-union or pseudarthrosis. Usually your surgeon will be able to tell whether a fusion has occurred by looking at X-rays taken over a three- to six-month period after surgery. If a fusion does not occur and you have no pain, a second surgery will not be necessary. If you continue to have pain, and a non-union is diagnosed after surgery, your surgeon may suggest a second attempt at fusion. When trying for the second time after a failed fusion, most surgeons will usually include some type of internal fixation, such as a plate and screws.

What is minimally invasive spine surgery and how is it different from traditional spine surgery?

Traditional spine surgery typically requires long incisions in the back. Muscles are cut and separated from the spine to allow access to the spinal anatomy. Minimally invasive spine surgery is performed through small incisions in the back. Surgeons use specialized instruments and navigational tools such as interoperative x-ray, pedi-guard, microscopes and tubular retractors. Like traditional spine surgery, the goal of minimally invasive surgery is to relieve your back and/or leg pain. But it adheres to a different philosophy—that as little muscle tissue as possible should be damaged.

What are the complications of spine surgery?

Like any surgery, there are a number of complications related to spine surgery. There are certain risks of general anaesthesia that are extremely rare and include death and other life-threatening reactions to anaesthesia. In experienced and well-trained hands, risk of paralysis or permanent nerve damage are extremely rare but can unfortunately still occur even in the best of hands. People with more severe preexisting spinal cord or nerve compression are at greater risk of this. There are certain measures that I take preoperatively and intraoperatively to monitor the spinal cord and nerves closely so that I am aware of the status of the spinal cord and nerves at all times during complex spine surgery cases when working around the spinal cord and placing instrumentation.

Other risks include infection, which is lessened by the use of antibiotics perioperatiely as well as placement of antibiotics directly into the wound.

Rods, screws, and plates, may fail and break or pull out. This risk is increased in people with poor bone quality including those with osteoporosis and smokers. Therefore preoperatively I try to assess risk of this problem in my patients and take measures pre and intraoperatively to prevent the likelihood of this from happening. I also advise all smokers to quit smoking prior to spine surgery as it increases the risk of infection, hardware failure, and generally an unhappy outcome.

There is a risk of the patient not actually improving after the spine surgery. I always advise patients who have seen a spine surgeon who recommended surgery for them to seek a second opinion on whether or not surgery is indicated and what surgery should be performed. I do not take the decision to operate on someone lightly and neither should the patient. I only operate on patients who I think I can help with surgery. If I do not feel surgery will benefit you, I will advise against it

In my practice as a spine surgeon in Bangalore at Bangalore spine specialist clinic as an orthopaedic spine surgeon in Bangalore, I have come across that people in Bangalore are unaware about the  risks and benifits of spine surgery. The mistrust towards spine surgery results is still prevelant.  Bangalore spine specialist Clinic, the best orthopaedic spine clinic in Bangalore agrees with the above details relating to the spinal surgery. Best spine surgeon in Bangalore can deal with variety of spinal disorders related to back pain treatement and neck pain treatment in Bangalore. Top Spine Surgeons in Bangalore can provide proper evaluation and treatment for back pain in Bangalore

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