CT myelography is occasionally more accurate in diagnosing nerve root compression in the lateral recess [48,49], but it has the disadvantage of requiring lumbar puncture for intrathecal injection of myelographic 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 the evaluation of new or progressing symptoms in patients with previous lumbar surgery. FDG-PET/CT Whole Body There is no relevant literature to support the use of whole-body FDG-PET/CT in the evaluation of new or progressing symptoms in patients with previous lumbar surgery. 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 MRI lumbar spine without and with IV contrast is useful as it accurately distinguishes recurrent or residual disc herniations from scar, and can evaluate for nerve root compression or arachnoiditis in patients with new or progressive symptoms and previous lumbar surgery [43]. It can also help identify and evaluate extent of infection. MRI Lumbar Spine Without IV Contrast MRI lumbar spine without IV contrast can be useful in this clinical scenario. It is inferior to MRI lumbar spine without and with IV contrast for evaluating extent of infection and for differentiating postoperative epidural fibrosis (scar) from residual or recurrent disc herniations [43]. Radiography Lumbar Spine Radiography is helpful to evaluate alignment and hardware integrity in patients with new or progressing symptoms and previous lumbar fusion. Upright radiographs provide useful functional information about axial loading. Flexion and extension radiographs can be used to look for abnormal motion/increased dynamic mobility [50].
Low Back Pain PCAs. CT myelography is occasionally more accurate in diagnosing nerve root compression in the lateral recess [48,49], but it has the disadvantage of requiring lumbar puncture for intrathecal injection of myelographic 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 the evaluation of new or progressing symptoms in patients with previous lumbar surgery. FDG-PET/CT Whole Body There is no relevant literature to support the use of whole-body FDG-PET/CT in the evaluation of new or progressing symptoms in patients with previous lumbar surgery. 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 MRI lumbar spine without and with IV contrast is useful as it accurately distinguishes recurrent or residual disc herniations from scar, and can evaluate for nerve root compression or arachnoiditis in patients with new or progressive symptoms and previous lumbar surgery [43]. It can also help identify and evaluate extent of infection. MRI Lumbar Spine Without IV Contrast MRI lumbar spine without IV contrast can be useful in this clinical scenario. It is inferior to MRI lumbar spine without and with IV contrast for evaluating extent of infection and for differentiating postoperative epidural fibrosis (scar) from residual or recurrent disc herniations [43]. Radiography Lumbar Spine Radiography is helpful to evaluate alignment and hardware integrity in patients with new or progressing symptoms and previous lumbar fusion. Upright radiographs provide useful functional information about axial loading. Flexion and extension radiographs can be used to look for abnormal motion/increased dynamic mobility [50].