Plain Radiographs (X-Rays)
The main purpose of plain x-rays is to detect serious underlying
structural and/or pathologic conditions. The typical types of x-rays
we order are AP, lateral, flexion/extension, and outlet films to
help us determine if there is degenerative arthritis, a fracture,
malalignment or motion between vertebral levels (instability).
Bone Scan
Bone scans are rarely needed to evaluate acute low back pain. They
can be helpful in cases where a tumor, infection, fracture, or CRPS
is suspected. A positive bone scan finding should generally be
followed by confirmatory imaging such as MRI or CT, which help
provide better anatomic detail of the spine.
Magnetic Resonance Imaging (MRI)
MRI has demonstrated excellent sensitivity in diagnosing lumbar
disc herniation and is considered the imaging study of choice. The
specific indications for a patient to have an immediate MRI include
progressive neurological deficits, bowel/bladder dysfunction and
patients with a possible malignancy or inflammatory condition.
MRI may be helpful in patients with neurogenic claudication due
to suspected central or foraminal stenosis. MRI’s can also be useful
to help determine the level of pathology in patients when physical
examination and electrodiagnostic findings are otherwise not
definitive. Some clinicians reserve MRI for those patients not
responding to treatment as expected.
Computer Tomography (CT)
CT imaging of the lumbar spine provides superior anatomic imaging
of the bones in the spine and good resolution for disc herniation.
It is less sensitivity for detecting disc herniation when used
without myelography than an MRI. CT imaging is best used when
there is a suspected fracture or tumor, but can also be used to
detect a disc injury in patients who cannot undergo MRI scanning.
