MRI lumbar spine without and with IV contrast is useful, as it accurately distinguishes recurrent or residual disc herniations from scar, and can evaluate for nerve root compression or arachnoiditis in patients with new or progressive symptoms and previous lumbar surgery [43]. It can also help identify and evaluate extent of infection. CT lumbar spine without IV contrast can be helpful in assessing osseous fusion. CT can detect potentially painful hardware failure including prosthetic loosening, malalignment, or metallic fracture [44]. Additionally, CT lumbar spine without IV contrast is equal to MRI for predicting significant spinal stenosis and excluding cauda equina impingement [27]. The addition of IV contrast is not necessary to evaluate bony fusion and hardware but may be useful to assess for epidural abscess in patients for this clinical scenario [45-47]. CT myelography of the lumbar spine can be useful in assessing the patency of the spinal canal/thecal sac and of the subarticular recesses and neural foramen [22]. It has safety advantages over MRI for patients who have implanted medical devices that are not MRI safe or conditional and can be useful in patients with significant artifact from metallic surgical hardware on MRI [23]. CT myelography is occasionally more accurate in diagnosing nerve root compression in the lateral recess [48,49] but has the disadvantages of requiring lumbar puncture for intrathecal injection of myelographic contrast[22]. In patients in whom anatomy is distorted secondary to artifacts from surgical hardware, CT myelography lumbar spine study is complementary to MRI and is occasionally more accurate in diagnosing nerve root compression in the lateral recess [48,49], but it suffers the disadvantage of requiring lumbar puncture and intrathecal contrast injection [22]. Radiography is complementary to MRI and/or CT imaging and is helpful to evaluate alignment and hardware integrity in patients with new or progressing symptoms and previous lumbar fusion.
Low Back Pain PCAs. MRI lumbar spine without and with IV contrast is useful, as it accurately distinguishes recurrent or residual disc herniations from scar, and can evaluate for nerve root compression or arachnoiditis in patients with new or progressive symptoms and previous lumbar surgery [43]. It can also help identify and evaluate extent of infection. CT lumbar spine without IV contrast can be helpful in assessing osseous fusion. CT can detect potentially painful hardware failure including prosthetic loosening, malalignment, or metallic fracture [44]. Additionally, CT lumbar spine without IV contrast is equal to MRI for predicting significant spinal stenosis and excluding cauda equina impingement [27]. The addition of IV contrast is not necessary to evaluate bony fusion and hardware but may be useful to assess for epidural abscess in patients for this clinical scenario [45-47]. CT myelography of the lumbar spine can be useful in assessing the patency of the spinal canal/thecal sac and of the subarticular recesses and neural foramen [22]. It has safety advantages over MRI for patients who have implanted medical devices that are not MRI safe or conditional and can be useful in patients with significant artifact from metallic surgical hardware on MRI [23]. CT myelography is occasionally more accurate in diagnosing nerve root compression in the lateral recess [48,49] but has the disadvantages of requiring lumbar puncture for intrathecal injection of myelographic contrast[22]. In patients in whom anatomy is distorted secondary to artifacts from surgical hardware, CT myelography lumbar spine study is complementary to MRI and is occasionally more accurate in diagnosing nerve root compression in the lateral recess [48,49], but it suffers the disadvantage of requiring lumbar puncture and intrathecal contrast injection [22]. Radiography is complementary to MRI and/or CT imaging and is helpful to evaluate alignment and hardware integrity in patients with new or progressing symptoms and previous lumbar fusion.