Upright radiographs provide useful functional information about axial loading. Flexion and extension views can be performed to evaluate for spine stability. However, evaluation of the extent of vertebral body comminution is limited on radiography, particularly in patients with osteoporosis. CT provides a detailed analysis of fractures extending to the posterior column of the vertebra or for evaluating the integrity of pedicles and the posterior cortex. It has been shown to be equal to MRI for predicting significant spinal stenosis and excluding cauda equina impingement [27]. Low Back Pain CT myelography of the lumbar spine assess the patency of the spinal canal/thecal sac and of the subarticular recesses and neural foramen [22]. It can be useful in patients with osteoporotic fracture with neurologic deficit. This modality has the disadvantage of lumbar puncture and injection of intrathecal contrast [22]. Bone scan with SPECT/CT is usually not used for initial imaging but can be useful for radiographically occult fractures and can be used to evaluate acuity of vertebral fracture. [59]. Whole-body FDG-PET/CT is typically not an initial imaging study, but as a follow-up study, it can help distinguish between benign and pathologic compression fractures when other imaging modalities are indeterminate [60]. Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine Bone scan with SPECT/CT is usually not used for initial imaging but can be useful for radiographically occult fractures and can be used to evaluate acuity of vertebral fracture [59]. CT Lumbar Spine With IV Contrast CT with IV contrast does not provide additional information to CT lumbar spine without IV contrast for evaluation of spinal fractures and alignment. CT Lumbar Spine Without and With IV Contrast CT without and with IV contrast of the lumbar spine is not typically performed as there is no diagnostic advantage to performing a single study with or without IV contrast.
Low Back Pain PCAs. Upright radiographs provide useful functional information about axial loading. Flexion and extension views can be performed to evaluate for spine stability. However, evaluation of the extent of vertebral body comminution is limited on radiography, particularly in patients with osteoporosis. CT provides a detailed analysis of fractures extending to the posterior column of the vertebra or for evaluating the integrity of pedicles and the posterior cortex. It has been shown to be equal to MRI for predicting significant spinal stenosis and excluding cauda equina impingement [27]. Low Back Pain CT myelography of the lumbar spine assess the patency of the spinal canal/thecal sac and of the subarticular recesses and neural foramen [22]. It can be useful in patients with osteoporotic fracture with neurologic deficit. This modality has the disadvantage of lumbar puncture and injection of intrathecal contrast [22]. Bone scan with SPECT/CT is usually not used for initial imaging but can be useful for radiographically occult fractures and can be used to evaluate acuity of vertebral fracture. [59]. Whole-body FDG-PET/CT is typically not an initial imaging study, but as a follow-up study, it can help distinguish between benign and pathologic compression fractures when other imaging modalities are indeterminate [60]. Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine Bone scan with SPECT/CT is usually not used for initial imaging but can be useful for radiographically occult fractures and can be used to evaluate acuity of vertebral fracture [59]. CT Lumbar Spine With IV Contrast CT with IV contrast does not provide additional information to CT lumbar spine without IV contrast for evaluation of spinal fractures and alignment. CT Lumbar Spine Without and With IV Contrast CT without and with IV contrast of the lumbar spine is not typically performed as there is no diagnostic advantage to performing a single study with or without IV contrast.