MRI Lumbar Spine Without and With IV Contrast MRI with IV contrast is typically not necessary in the evaluation of a surgical or interventional candidate with persistent or progressive symptoms during or following 6 weeks of conservative management but is sometimes useful if noncontrast MRI is nondiagnostic or indeterminate. Contrast can help distinguish residual/recurrent disc from fibrosis/scar in a postoperative patient (see Variant 5). MRI Lumbar Spine Without IV Contrast Patients presenting with subacute or chronic LBP or radiculopathy who have failed 6 weeks of conservative therapy, and with physical examination signs of nerve root irritation, should be imaged if they are believed to be candidates for surgery or intervention or if diagnostic uncertainty remains. Accurate diagnosis of disc disease can be provided by MRI [7]. Although disc abnormalities are common on MRI in asymptomatic patients, LBP with radiculopathy or clinical signs of spinal stenosis suggests the presence of demonstrable nerve root compression on MRI [13]. In a study of symptomatic patients, there was a higher prevalence of herniation. Fifty-seven percent of patients with LBP and 65% of patients with radiculopathy had disc herniation as compared with the 20% to 28% prevalence reported in the asymptomatic series [7]. Interestingly, the size and type of disc herniation and location and presence of nerve root compression were not related to patient outcome [7,34]. Kobayashi et al [35] have shown the utility of MRI in diagnosing active spondylolysis in radiographically occult spondylolysis. Radiography Lumbar Spine Although radiography alone is not sufficient for guidance on surgical or interventional options without MRI and/or CT imaging, it can be seen as complementary. Upright radiographs provide useful functional information about axial loading [36].
Low Back Pain PCAs. MRI Lumbar Spine Without and With IV Contrast MRI with IV contrast is typically not necessary in the evaluation of a surgical or interventional candidate with persistent or progressive symptoms during or following 6 weeks of conservative management but is sometimes useful if noncontrast MRI is nondiagnostic or indeterminate. Contrast can help distinguish residual/recurrent disc from fibrosis/scar in a postoperative patient (see Variant 5). MRI Lumbar Spine Without IV Contrast Patients presenting with subacute or chronic LBP or radiculopathy who have failed 6 weeks of conservative therapy, and with physical examination signs of nerve root irritation, should be imaged if they are believed to be candidates for surgery or intervention or if diagnostic uncertainty remains. Accurate diagnosis of disc disease can be provided by MRI [7]. Although disc abnormalities are common on MRI in asymptomatic patients, LBP with radiculopathy or clinical signs of spinal stenosis suggests the presence of demonstrable nerve root compression on MRI [13]. In a study of symptomatic patients, there was a higher prevalence of herniation. Fifty-seven percent of patients with LBP and 65% of patients with radiculopathy had disc herniation as compared with the 20% to 28% prevalence reported in the asymptomatic series [7]. Interestingly, the size and type of disc herniation and location and presence of nerve root compression were not related to patient outcome [7,34]. Kobayashi et al [35] have shown the utility of MRI in diagnosing active spondylolysis in radiographically occult spondylolysis. Radiography Lumbar Spine Although radiography alone is not sufficient for guidance on surgical or interventional options without MRI and/or CT imaging, it can be seen as complementary. Upright radiographs provide useful functional information about axial loading [36].