Back Pain


Radiologic procedure

Ratinga

Comments

X-ray lumbar spine

7

Initial study of choice especially in setting of osteoporosis or osteoporosis risk factors

CT lumbar spine without contrast

7

If suspicion for fracture is high and X-ray is negative

MRI lumbar spine without contrast

7

Can evaluate for ligamentous injury or in setting of worsening neuro deficit

Tc-99m bone scan with SPECT spine

3

Can uncover radiographically occult fractures

CT lumbar spine with contrast

3
 
CT lumbar spine with/without contrast

1
 
X-ray myelography and post-myelography CT lumbar spine

1
 
X-ray discography and post-discography
  
CT lumbar spine

1
 

aRating scale: 1, 2, and 3 usually not appropriate; 4, 5, and 6 may be appropriate; 7, 8, and 9 usually appropriate





Scenario 2

Acute, subacute, or chronic low back pain or radiculopathy. One or more of the following: suspicion of cancer, infection, or immunosuppression
















































Radiologic procedure

Ratinga

Comments

MRI lumbar spine with/without contrast

8

Contrast helps for cancer patients suspected of epidural or intraspinal disease

MRI lumbar spine without contrast

7

Sufficient if low risk of epidural or intraspinal disease

CT lumbar spine with contrast

6

If MRI is contraindicated

CT lumbar spine without contrast

6

If MRI is contraindicated

X-ray lumbar spine

5
 

Tc-99m bone scan with SPECT spine

4

Helps with anatomic localization if widespread metastasis is suspected

FDG-PET/CT whole body

4

Can help distinguish benign from malignant compression fractures but MRI is better

CT lumbar spine with/without contrast

3

If MRI is contraindicated

X-ray myelography and post-myelography CT lumbar spine

3

If MRI is contraindicated can be useful for anatomic localization and problem solving


aRating scale: 1, 2, and 3 usually not appropriate; 4, 5, and 6 may be appropriate; 7, 8, and 9 usually appropriate


Scenario 3

Acute, subacute, or chronic low back pain or radiculopathy. Surgery or intervention candidate with persistent or progressive symptoms during or following 6 weeks of conservative management












































Radiologic procedure

Ratinga

Comments

MRI lumbar spine without contrast

8
 

CT lumbar spine with contrast

5

If MRI is contraindicated

CT lumbar spine without contrast

5

If MRI is contraindicated

MRI lumbar spine with/without contrast

5

If MRI without contrast is nondiagnostic or if history of prior lumbar surgery

X-ray lumbar spine

4

Usually not sufficient by itself but can help with surgical planning

Tc-99m bone scan with SPECT spine

4

Useful for facet arthropathy or stress fracture

X-ray discography and post-discography
   

CT lumbar spine

3

Controversial, but may be helpful in patients with pain >3 months


aRating scale: 1, 2, and 3 usually not appropriate; 4, 5, and 6 may be appropriate; 7, 8, and 9 usually appropriate


Scenario 4

Low back pain or radiculopathy. New or progressing symptoms or clinical findings with history of prior lumbar surgery




















Radiologic procedure

Ratinga

Comments

MRI lumbar spine with/without contrast

8

Can differentiate disc from scar

CT lumbar spine with contrast

6

Useful in postfusion patients or when MRI is contraindicated or nondiagnostic

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Nov 20, 2017 | Posted by in Uncategorized | Comments Off on Back Pain

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