CT Myelography Lumbar Spine CT myelography of the lumbar spine assesses 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]. Discography and Post-Discography CT Lumbar Spine There is no relevant literature to support the use of discography and post-discography CT lumbar spine in this clinical scenario. FDG-PET/CT Whole Body 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]. MRI Lumbar Spine With IV Contrast MRI lumbar spine with IV contrast is not typically performed independently as an initial study, as its interpretation is most informative when correlated with standard noncontrast sequences included in MRI lumbar spine with and without IV contrast [33]. MRI Lumbar Spine Without and With IV Contrast Although MRI lumbar spine without IV contrast is the preferred initial study, MRI lumbar spine without and with IV contrast may be helpful to delineate etiology of fracture when clinical suspicion of underlying malignancy, infection, or inflammation (see Variant 7). MRI Lumbar Spine Without IV Contrast MRI lumbar spine without IV contrast is useful in determining the acuity of a vertebral fracture, as evidenced by bone marrow edema and in demonstrating spinal canal compromise, for example from displaced or retropulsed Low Back Pain fractures. Additionally, the distinction between malignant and benign compression fractures can be assessed on MRI. The visualization of the convex posterior vertebral body border, extension into the posterior elements, and abnormal marrow signal are suggestive of pathologic fracture [58].
Low Back Pain PCAs. CT Myelography Lumbar Spine CT myelography of the lumbar spine assesses 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]. Discography and Post-Discography CT Lumbar Spine There is no relevant literature to support the use of discography and post-discography CT lumbar spine in this clinical scenario. FDG-PET/CT Whole Body 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]. MRI Lumbar Spine With IV Contrast MRI lumbar spine with IV contrast is not typically performed independently as an initial study, as its interpretation is most informative when correlated with standard noncontrast sequences included in MRI lumbar spine with and without IV contrast [33]. MRI Lumbar Spine Without and With IV Contrast Although MRI lumbar spine without IV contrast is the preferred initial study, MRI lumbar spine without and with IV contrast may be helpful to delineate etiology of fracture when clinical suspicion of underlying malignancy, infection, or inflammation (see Variant 7). MRI Lumbar Spine Without IV Contrast MRI lumbar spine without IV contrast is useful in determining the acuity of a vertebral fracture, as evidenced by bone marrow edema and in demonstrating spinal canal compromise, for example from displaced or retropulsed Low Back Pain fractures. Additionally, the distinction between malignant and benign compression fractures can be assessed on MRI. The visualization of the convex posterior vertebral body border, extension into the posterior elements, and abnormal marrow signal are suggestive of pathologic fracture [58].