Radiography Lumbar Spine In patients with history of osteoporosis or steroid use, initial evaluation with radiography is useful [55]. Radiography with anteroposterior and lateral radiographs is useful for assessing LBP in patients with low suspicion of trauma or minor trauma and patients suspected of having possible vertebral compression fracture. Upright radiographs provide useful functional information about axial loading. Flexion and extension views can be performed to evaluate for spine stability. Evaluation of the extent of vertebral body comminution is limited on radiography, particularly in patients with osteoporosis. Variant 7: Low back pain with or without radiculopathy. One or more of the following: suspicion of cancer, infection, or immunosuppression. Initial imaging. A systematic review examining studies that used red flags as an indication for screening found that of all the red flags, only a history of cancer has been shown to increase the probability of finding spinal malignancy [61]. In a patient suspected of having cancer, MRI without and with IV contrast is considered superior in evaluation of localizing disease (intramedullary, intradural-extramedullary, and extradural) as well as assessing extent of the lesion. For malignant/metastatic disease, both bony/marrow involvement and neural compression from epidural tumor are visualized with high spatial resolution [62]. Although CT lumbar spine without IV contrast can be performed to evaluate osseous integrity (eg, pathologic fracture) when involved with tumor, intradural and spinal cord pathologies are poorly depicted on CT. Bone scan remains invaluable when a survey of the entire skeleton is indicated (eg, for metastatic disease); however, MRI offers greater specificity than bone scan, with comparable sensitivity and the added advantage of providing anatomic detail [63].
Low Back Pain PCAs. Radiography Lumbar Spine In patients with history of osteoporosis or steroid use, initial evaluation with radiography is useful [55]. Radiography with anteroposterior and lateral radiographs is useful for assessing LBP in patients with low suspicion of trauma or minor trauma and patients suspected of having possible vertebral compression fracture. Upright radiographs provide useful functional information about axial loading. Flexion and extension views can be performed to evaluate for spine stability. Evaluation of the extent of vertebral body comminution is limited on radiography, particularly in patients with osteoporosis. Variant 7: Low back pain with or without radiculopathy. One or more of the following: suspicion of cancer, infection, or immunosuppression. Initial imaging. A systematic review examining studies that used red flags as an indication for screening found that of all the red flags, only a history of cancer has been shown to increase the probability of finding spinal malignancy [61]. In a patient suspected of having cancer, MRI without and with IV contrast is considered superior in evaluation of localizing disease (intramedullary, intradural-extramedullary, and extradural) as well as assessing extent of the lesion. For malignant/metastatic disease, both bony/marrow involvement and neural compression from epidural tumor are visualized with high spatial resolution [62]. Although CT lumbar spine without IV contrast can be performed to evaluate osseous integrity (eg, pathologic fracture) when involved with tumor, intradural and spinal cord pathologies are poorly depicted on CT. Bone scan remains invaluable when a survey of the entire skeleton is indicated (eg, for metastatic disease); however, MRI offers greater specificity than bone scan, with comparable sensitivity and the added advantage of providing anatomic detail [63].