An MRI of the lumbar spine shows the bones, disks, spinal cord, and the spaces between the vertebral bones where nerves pass through.

Lumbar spine magnetic resonance imaging (LSMRI) is recommended for low back pain LBP patients with “red flags” for systemic diseases, and when surgery is considered for patients presenting signs and symptoms of radicular compression. The latter applies when cauda equina syndrome is suspected, and in cases of radicular pain caused by disc herniation (when conservative treatment has failed for ≥6 weeks) or spinal stenosis (when conservative treatment has failed for ≥12 weeks) 1) 2) 3) 4) 5).

LSMRI is not recommended when there are no signs suggesting that the pain is caused by systemic diseases or radicular compression. In these cases, any potential findings on LSMRI have shown to be irrelevant, and do not help to refine the diagnosis, improve the outcome, or predict patient evolution 6) 7) 8) 9).

LSMRI performed prospectively on 602 patients in 12 Radiology Services across 6 regions in Spain, were classified as “appropriate”, “uncertain” or “inappropriate” based on the indication criteria established by the National Institute for Clinical Excellence, the American College of Physicians and Radiology, and current evidence-based clinical guidelines. Studies on patients reporting at least one “red flag” were classified as “appropriate”. A logistic regression model was developed to identify factors associated with a higher likelihood of inappropriate LSMRI, including gender, reporting of referred pain, health care setting (private/public), and specialty of prescribing physician. Before performing the LSMRI, the radiologists also assessed the appropriateness of the prescription.

Eighty-eight percent of LSMRI were appropriate, 1.3% uncertain and 10.6% inappropriate. The agreement of radiologists' assessment with this classification was substantial (k=0.62). The odds that LSMRI prescriptions were inappropriate were higher for patients without referred pain [OR (CI 95%): 13.75 (6.72; 28.16)], seen in private practice [2.25 (1.20; 4.22)], by orthopedic surgeons, neurosurgeons or primary care physicians [2.50 (1.15; 5.56)].

Efficiency of LSMRI could be improved in routine practice, without worsening clinical outcomes 10).

Lumbar nerve root entrapment syndromes cause radicular signs and symptoms in the affected leg. The applicability of diffusion-weighted imaging (DWI) for the assessment of lower lumbar nerves (L4-S1) has been demonstrated.

In human lumbosacral spinal nerves (L1-S1), using diffusion-weighted magnetic resonance imaging techniques. 3 T ADC maps have a higher signal to noise ratio, thus offering better image quality. Results from this study suggest that DWI has added value as new diagnostic tools for patients with symptomatic lumbar nerve root entrapment syndromes as well 11).

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Kovacs FM, Arana E, Royuela A, Cabrera A, Casillas C, Piñero P, Vega M, Asenjo B, Estremera A, Amengual G, Sarasíbar H, Ferrer P, Manjarrés A, Zamarro J, Bravo-Rodríguez F, Paniagua JC, Mota J, Sánchez-Sagrado T, Abraira V, Martínez C. Appropriateness of lumbar spine magnetic resonance imaging in Spain. Eur J Radiol. 2013 Jun;82(6):1008-14. doi: 10.1016/j.ejrad.2013.01.017. Epub 2013 Feb 16. PubMed PMID: 23422282.
Reinhold M, Ederer C, Henninger B, Eberwein A, Kremser C. Diffusion-weighted magnetic resonance imaging for the diagnosis of patients with lumbar nerve root entrapment syndromes: results from a pilot study. Eur Spine J. 2014 Oct 9. [Epub ahead of print] PubMed PMID: 25297703.
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