CT Lumbar Spine Without IV Contrast CT lumbar spine without IV contrast may be useful for preoperative planning [26]. CT delineates osseous margins and aids in trajectory planning for hardware fixation. Additionally, CT lumbar spine without IV contrast can be used to assess facets and neural foramina in patients who cannot undergo MRI and is equal to MRI for predicting significant spinal stenosis and excluding cauda equina impingement [27]. CT Myelography Lumbar Spine 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 has the disadvantage of requiring lumbar puncture for intrathecal injection of myelographic contrast [22]. Low Back Pain Discography and Post-Discography CT Lumbar Spine Although the utility of discography in patients with LBP remains controversial, a systematic review by Manchikanti et al [32] provides level III evidence that lumbar discography may be useful in patients with chronic discogenic LBP. FDG-PET/CT Whole Body There is no relevant literature to support the use of whole-body FDG-PET/CT in the evaluation of a surgery or intervention candidate with persistent or progressive symptoms during or following 6 weeks of conservative management [28-30]. 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].
Low Back Pain PCAs. CT Lumbar Spine Without IV Contrast CT lumbar spine without IV contrast may be useful for preoperative planning [26]. CT delineates osseous margins and aids in trajectory planning for hardware fixation. Additionally, CT lumbar spine without IV contrast can be used to assess facets and neural foramina in patients who cannot undergo MRI and is equal to MRI for predicting significant spinal stenosis and excluding cauda equina impingement [27]. CT Myelography Lumbar Spine 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 has the disadvantage of requiring lumbar puncture for intrathecal injection of myelographic contrast [22]. Low Back Pain Discography and Post-Discography CT Lumbar Spine Although the utility of discography in patients with LBP remains controversial, a systematic review by Manchikanti et al [32] provides level III evidence that lumbar discography may be useful in patients with chronic discogenic LBP. FDG-PET/CT Whole Body There is no relevant literature to support the use of whole-body FDG-PET/CT in the evaluation of a surgery or intervention candidate with persistent or progressive symptoms during or following 6 weeks of conservative management [28-30]. 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].