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Radiography provides vital visual information to ensure diagnostic and surgical accuracy. Photo: Shutterstock

3 common spinal conditions explained by radiographer who gets first look

  • Advancing scanning technology allows precision in both diagnosis and surgery
  • Degeneration once associated with old ages is affecting more young sufferers
In partnership with:Hong Kong Adventist Hospital

Today’s urban life puts a lot of stress on our bodies, both mentally and physically. We ignore minor aches and pains, to our own perils. Often by the time we visit the doctor, the condition has already become rather serious.

Lam Wai-hong, diagnostic radiographer II at Hong Kong Adventist Hospital – Stubbs Road, has seen it with his own eyes – literally. Through various types of scanning equipment, he provides important visual information to aid the doctor’s diagnosis and prescription of treatments.

Lam has 23 years of experience, working for both public and private hospitals. Throughout the years, he has kept up to date with advancing technology.

Windows into our bodies

Plain X-ray films are still the first go-to for spotting skeletal anomalies.

“In serious cases where bones are dislocated, you can see through the X-ray. But as the X-ray can’t demonstrate the bones with fluids clearly, conditions affecting the nerves can only be seen through MRI (magnetic resonance imaging),” Lam says.

Until recently, C-arm MRI equipment was only able to provide 2D images in the operating theatre, but the introduction of O-arm has changed everything. In spinal surgeries that require implanting supportive structures such as rods and screws, this new intraoperative technology gives the surgeon precise data.

If there is calcification on the front side, then the surgery needs to be done from the back side
Lam Wai-hong, diagnostic radiographer

“With O-arm, as it’s a 3D scan, it can help the doctor accurately determine where the screws, if needed, should be set, as well as their widths and lengths,” Lam says.

O-arm also shows conditions such as calcification of the bones, and helps the doctor determine how the surgery should be approached.

“If there is calcification on the front side, then the surgery needs to be done from the back side.”

Touching a nerve

One of the common conditions that MRI can show is the prolapsed intervertebral disc (PID), or what many call a ‘slipped disc’. But the term is actually a misnomer, as the ‘discs’ are gel-like tissues between bones that help absorb shock. They do not slide, but under high pressure, they can protrude and come into contact or even press the nerves, which can result in great pain.

Many cases of severe back pains are caused by a condition called the prolapsed intervertebral disc, commonly referred to as “a slipped disc”. Photo: Shutterstock

PID often happens to those whose work involves lifting heavy items or, for some medical professionals, people.

“In our line work, we often have to lift patients from one bed to another, and if not careful, it doesn’t take many times to come down with PID symptoms,” Lam says.

“It often happens when you have bad postures and extra pressure is put on a couple of joints. It’s usually around the lumbar spine region, which is the lower back.”

Although the prolapsed intervertebral disc (PID) is often called “a slipped disc”, the term is a misnomer, as a disc is gel-like tissues in the joint and it does not slip. But in the case of PID, excessive pressures cause part of a disc to protrude and come in contact with the nearby nerves. Graphic: SCMP

Lam adds that as nerve signals travel to and from the brain, the further up the anomaly, the wider the area of pain.

PID symptoms, given rest, can fade and disappear on their own. In more serious cases, the sufferer may need physiotherapy – or surgery.

Pain the neck

Hong Kong workplaces are notorious for their breakneck pace, unfortunately in more ways than one.

All those hours you spend tilting your head down looking at the computer screen and your mobile can cause a condition called spondylosis. It is generally a natural occurrence of ageing where discs lose fluid, become stiffer, and are more likely to crack and flake away.

Bad postures at work and the habitual use of the smartphone have caused more young people to have accelerated spinal degeneration, especially around the neck. Photo: Shutterstock

Lam says that this condition commonly happens to people in their 70s or 80s, but alarmingly, it is also affecting an increasing number of much-younger patients, some of them barely 40.

From plain X-ray films, you often see patients’ skeletal conditions not matching their actual ages. Some bones are noticeably worn out
Lam Wai-hong

“With spondylosis, you can usually see the anomaly through X-ray. Oftentimes you can see a joint space that is narrower compared to others,” Lam says.

“Working with a computer in bad postures can cause some of the seven bones in the neck to withstand extra pressure and, as a result, degenerate at an accelerated rate,” he says.

“From plain X-ray films, you often see patients’ skeletal conditions not matching their actual ages. Some bones are noticeably worn out, usually occurring in C5-6, and C6-7.”

In some cases, the deterioration may have progressed to the point where the disc needs to be replaced, and this is when O-arm is the most helpful as it can ensure the accuracy of the replacement.

Spondylosis occurs when discs have lost so much fluid, they crack and flake away. This condition is generally due to ageing but can be accelerated by bad habits. Graphic: SCMP

Born this way

Another common spinal problem, scoliosis, remains somewhat a mystery.

“As far as I know, this condition is inborn and there are no known factors. It happens to women more than men,” Lam says. “The most visible symptom is the uneven shoulders.”

A scoliosis sufferer’s spine forms a noticeable curve instead of a straight line as it normally should be. It is an inborn condition and it affects women more than men. Photo: Shutterstock.

Through the X-ray, one can easily see sufferers’ backbones curving into either a C or S shape, as opposed to a straight spine. When the curvature is more than 10 degrees, it is considered a case of scoliosis.

Scoliosis is often initially discovered by parents, who detect the anomaly by pressing their children’s backs. “More serious cases can affect organs such as the heart and the lungs,” Lam says.

When the X-ray shows a patient’s spine curving to the side or to the back at more than 10 degrees, it will be considered a case of scoliosis. Graphic: SCMP

This is also when O-arm comes in handy, as the surgery involves straightening the spine and implanting two rods to support it, with screws put in at various joints to stabilise the structure.

“Some surgeries can involve 10 or even more screws, and having all the accurate data beforehand helps save time and minimalise the risk of the procedure.”

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