Orthopedics Book

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Lumbar Spine MRIAka: L-Spine MRI

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  1. Indications
    1. Lumbosacral Radiculopathy
    2. Spinal Cord Abscess (Spinal Osteomyelitis)
    3. Spinal Cord Tumor
    4. Spinal stenosis
    5. Nontraumatic vascular injuries of the spine
  2. Contraindications: Implantable Device
    1. Pacemaker
    2. Ferromagnetic vascular clip
    3. Intracranial clips
    4. Other metal or magnetic devices
    5. Claustrophobia (less in open-sided MRI)
  3. Pitfalls: Coincidental Findings in pain free patients
    1. Asymptomatic Under 60 years old
      1. Bulging disc: 33%
      2. Herniated disc: 20%
      3. Unexpected XRay finding: 0.0004% (1 in 2500)
    2. Asymptomatic Over 60 years old
      1. Degenerative changes: 100%
      2. Bulging disk: 80%
      3. Herniated disk: 33%
      4. Spinal stenosis: 20%
    3. References
      1. Boden (1990) J Bone Joint Surg Am 72:403
      2. Boos (1995) Spine 20:2613
  4. Disadvantages
    1. Expensive
    2. High false positive rate (asymptomatic changes)
    3. Very sensitive to patient movement
  5. Advantages
    1. No radiation
    2. Large area of spine covered
    3. Shows soft tissue well (e.g. nerve)
    4. Shows changes within disc and vertebral body
  6. Adjuncts: Gadolinium Contrast
    1. Not recommended if prior lumbar spine surgery
      1. Contrast in this case reduces accuracy
    2. May offer additional information in select cases
      1. Enhances nerve roots in inflammation and infection
      2. Distinguishes recurrent disc herniation from scar

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