Merits of Adding Coronal-STIR Sequence in a Routine Lumbo-Sacral Spine MR Imaging Protocol to Investigate Sciatica and Sciatica-Like Symptoms

Abstract

Background: Sciatica is defined by low back pain that radiates to the legs, with or without neurologic deficiency. sciatica or sciatica-like symptoms may result from spinal root compression in an extra-spinal location or from injury to the pelvic girdle. Aim: determine the value of coronal STIR sequence in the detection and diagnosis of extra-spinal causes of sciatica by adding it to routine MRI protocol of the lumbo-sacral spine in patients referred for sciatica-like symptoms. Methods: The current study involved an observational analysis for lumbo-sacral MRI examinations done for 50 patients, 22 males and 28 females, presenting with sciatica and sciatica-like symptoms. Results and conclusion: By adding a coronal STIR sequence to the routine MRI protocol, we were able to identify extra-spinal abnormalities that were not visible on routine sequences, in 10 patients (20%). 6 (8%) patients had abnormalities which were considered to be as a definite cause of sciatica and sciatica-like symptoms. In 4 (8%) patients, the coronal STIR also identified soft tissue abnormalities in the pelvis which were considered as equivocal causes of sciatica and sciatica-like symptoms. A higher prevalence of definite causes of extra-spinal sciatica was seen in patients between 24-40 years old. Also, prevalence of definite causes of sciatic pain was affected by history of neoplasia. Prevalence of definite causes of sciatic pain was not significantly affected by sex. However, most of the equivocal causes of sciatica were gynecological pathologies.