However, it is well known that many MRI abnormalities can be seen in asymptomatic individuals and that imaging patients in this category is often not beneficial [7,11,13,21]. MRI may be helpful when there is LBP with radiculopathy or signs of spinal stenosis, which suggests the presence of demonstrable nerve root compression [13]. Low Back Pain 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]. 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. The ability to incorporate flexion and extension radiographs is essential to identify segmental motion, which is important in the surgical management of spondylolisthesis. Lateral bending images have been shown to be helpful in spinal deformity correction surgery [24,25]. 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 also be used to assess facets and neural foramina and is equal to MRI for predicting significant spinal stenosis and excluding cauda equina impingement [27]. Although evidence is limited, recent small studies have suggested SPECT/CT bone scan may help identify the source of LBP in some patients, particularly when related to facet arthropathy or sacroiliac joint dysfunction [28- 30].
Low Back Pain PCAs. However, it is well known that many MRI abnormalities can be seen in asymptomatic individuals and that imaging patients in this category is often not beneficial [7,11,13,21]. MRI may be helpful when there is LBP with radiculopathy or signs of spinal stenosis, which suggests the presence of demonstrable nerve root compression [13]. Low Back Pain 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]. 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. The ability to incorporate flexion and extension radiographs is essential to identify segmental motion, which is important in the surgical management of spondylolisthesis. Lateral bending images have been shown to be helpful in spinal deformity correction surgery [24,25]. 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 also be used to assess facets and neural foramina and is equal to MRI for predicting significant spinal stenosis and excluding cauda equina impingement [27]. Although evidence is limited, recent small studies have suggested SPECT/CT bone scan may help identify the source of LBP in some patients, particularly when related to facet arthropathy or sacroiliac joint dysfunction [28- 30].