Imaging

Lumbosacral radiculopathy

Preliminary Diagnosis: Lumbosacral Radiculopathy

I. What imaging technique is first-line for this diagnosis

  • Noncontrasted extradural protocol MR of the lumbar and sacral spine in patients without a history of prior back surgery

  • In patients with prior back surgery, the first line for diagnosis is contrasted extradural protocol MR of lumbar and sacral spine

II. Describe the advantages and disadvantages of this technique for diagnosis of lumbosacral radiculopathy.

Advantages

  • The patient is not exposed to ionizing radiation.

  • Contrasted MR examinations are able to differentiate granulation tissue from recurrent disc.

Disadvantages

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

III. What are the contraindications for the first-line imaging technique?

  • Patients who contain Non MR compatible hardware.

IV. What alternative imaging techniques are available?

  • CT myelography

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of lumbosacral radiculopathy.

CT myelography

Advantages

  • May be performed in patients with non-MR compatible hardware

  • May be performed much faster than MR exams

Disadvantages

  • Exposed the patient to ionizing radiation

VI. What are the contraindications for the alternative imaging techniques?

CT myelography

  • Patients allergic to iodinated contrast

  • Relative contraindication in patients with renal failure

  • Patients in a hypocoagulable state (platelets <50k, INR >2.0)

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