Diagnostic imaging part 2: lumbar spine

Question 1

What is the single most over-requested diagnostic imaging procedure?

Answer 1

lumbar radiography

Question 2

What are the problems with so many extra lumbar radiographies?

Answer 2

Economic impact, irrelevant findings that lead to inappropriate diagnosis and treatment, and 50% of people will have an identifiable abnormality of the disc or spinal canal (asymptomatic)

Question 3

For those who are asymptomatic that get a lumbar MRI, _____% have an identifiable abnormality of the disc or spinal cord, _____% with disc protrusions, _______% with annular tears, but these findings do not predict the development of ___________

Answer 3

50, 27, 38, LBP

Question 4

Article from the lancet concluded that pts with LBP do not need to be imaged unless _________________________

Answer 4

there is serious pathology or red flags suspected or present, because it doesn’t improve outcomes

Question 5

what are the 2 most common views of the lumbar spine?

Answer 5

anteroposterior and lateral

Question 6

What does a 3 view of the lumbar spine consist of?

Answer 6

AP, lateral, and magnified coned lateral view of L5-S1

Question 7

What does a 5 view of the lumbar spine consist of?

Answer 7

AP, lateral, magnified coned lateral view of L5-S1, and incorporates a left and right oblique view

Question 8

What does a 7 view of the lumbar spine consist of?

Answer 8

AP, lateral, magnified coned lateral view of L5-S1, left and right oblique view, and flexion and extension view

Question 9

What to look for when looking at an AP view of the spine?

Answer 9

alignment and present of abnormal bone

Question 10

What to look for when looking at a lateral view of the spine?

Answer 10

Smooth, gentle curvature along: anterior vertebral bodies, posterior vertebral bodies, anterior base of the spinous processes, and the tips of the spinous processes

Question 11

With an oblique projection, we need to look at _______________; will show a _____________ view and fracture of the ______________

Answer 11

patency of the facet joint and pars interarticularis; Scottie dog, pars interarticularis

Question 12

In the oblique view of the spine, what does it mean if the Scottie dog has a collar?

Answer 12

there’s a fracture

Question 13

MRI is probably not medically necessary in adult patient with low back pain ___________ neurological deficits AND _________ signs of serious disease or “red flags” unless __________________

Answer 13

without; without; unless surgery is being considered

Question 14

Indications for lumbar MRI: Leg pain with or without associated _________ and documented focal neurologic deficit (such as ______________).

Answer 14

back pain; motor weakness, dermatomal sensory loss, or significant reflex abnormality

Question 15

Indications for lumbar MRI: Pain/radiculopathy in adults not improving despite ____________, which includes physical therapeutic modalities and appropriate pharmacologic intervention. Acutely in the setting of __________________

Answer 15

4 weeks of non-surgical treatment; major trauma

Question 16

Indications for lumbar MRI: Recent less severe trauma to the spine with abnormalities on ___________________

Answer 16

neurologic exam or abnormal x-ray or persistent localized pain

Question 17

Indications for lumbar MRI: Clinical suspicion of an infectious process such as ____________ involving the spine or spinal cord, spinal cord or adjacent structures or spaces.

Answer 17

abscess, osteomyelitis, or discitis

Question 18

Indications for lumbar MRI: Clinical suspicion of primary ___________ with symptoms and/or findings suggesting involvement of the spine, spinal cord, meninges or positive bone scan

Answer 18

lumbar spine cancer

Question 19

Indications for lumbar MRI: Clinical suspicion of lumbar __________ or lumbar ____________ compression with extremity weakness, bladder/bowel symptoms, ataxia, spasticity, spinal level sensory loss

Answer 19

myelopathy; nerve root or cauda equina

Question 20

Indications for lumbar MRI: Suspected spinal cord (conus medularis) ______ or spinal (cauda equina) cord __________

Answer 20

infarct; tumor

Question 21

Indications for lumbar MRI: Significant ____________. For pediatric patients where imaging of the entire spine is needed an MRI may be more appropriate to minimize ________________

Answer 21

scoliosis; radiation exposure

Question 22

Indications for lumbar MRI: In children, suspicion of ______________________

Answer 22

congenital or acquired abnormalities of spine and/or cauda equina or tethered cord

Question 23

Indications for lumbar MRI: Known diagnosis of cancer with suspicion of ___________________

Answer 23

metastases to the lumbar spine, meninges, or spinal cord

Question 24

Indications for lumbar MRI: Further investigation of spinal abnormality of ___________ cause seen on plain film

Answer 24

unknown or uncertain

Question 25

Indications for lumbar MRI: Findings consistent with ____________________ (bilateral sciatica, saddle anesthesia, bladder/bowel disturbance, etc.)

Answer 25

cauda equina syndrome

Question 26

Indications for lumbar MRI: Sign/symptoms suggestive of ____________ (pseudoclaudication; pain/numbness/tingling with activity, relieved by rest, sitting, spinal flexion; suggestive x-ray findings).

Answer 26

spinal stenosis