Magnetic Resonance Imaging Of Lumbosacral Spine Research Articles

An open-access lumbosacral spine MRI dataset with enhanced spinal nerve root structure resolution

Spinal cord injury (SCI) profoundly affects an individual’s ability to move. Fortunately, recent advancements in neuromodulation, particularly the spatio-temporal epidural electrical stimulation (EES) targeting the spinal nerve roots, promoted rapid rehabilitation of SCI patients. Such neuromodulation techniques require precise anatomical modelling of spinal cord. However, the lack of spine imaging datasets, especially high-quality magnetic resonance imaging (MRI) datasets highlighting nerve roots, hinders the translation of EES into medical practice. To address this problem, we introduce an open-access lumbosacral spine MRI dataset acquired in 14 healthy adults, using constructive interference in steady state (CISS) sequence, double echo steady state (DESS) sequence, and T2-weight turbo spin echo (T2-TSE) sequence, with enhanced nerve root resolution. The dataset also includes the corresponding anatomical annotations of nerve roots and the final reconstructed 3D spinal cord models. The quality of our dataset is assessed using image quality metrics implemented in MRI quality control tool (MRIQC). Our dataset provides a valuable platform to promote a wide range of spinal cord neuromodulation research and collaboration among neurorehabilitation engineers.

Correlation between Vertebral Marrow Fat Fraction in MRI Using DIXON Technique and BMD in DXA in Patients of Suspected Osteoporosis.

Aim Osteoporosis is a common metabolic bone disease accounting for low back pain (LBP). It is diagnosed by dual-energy X-ray absorptiometry (DXA). Magnetic resonance imaging (MRI), a routine investigation for LBP, is also sensitive to detect fat fraction (FF) of the vertebral body that increases with increasing age. This study aimed to correlate vertebral marrow FF using MRI and bone mineral density (BMD). Material and Methods Patients presenting with low backache and suspected osteoporosis were included. All patients underwent an MRI of lumbosacral spine and DXA. Patients were categorized into an osteoporotic and a nonosteoporotic group based on the T-score obtained from DXA. "T-scores" of < -2.5 on BMD were considered as osteoporotic spine. T-score of > -2.5 was considered as nonosteoporotic. The FF obtained from the DIXON sequence of MRI was correlated between the two groups. Result Thirty-one patients were included with a mean age of 54.26 ± 11.6 years. Sixteen patients were osteoporotic based on the defined criteria in the methods. The mean vertebral marrow FF was significantly higher in the osteoporotic patients (64.98 ± 8.8%) compared with the nonosteoporotic (45.18 ± 13.2%) ( p = 0.001). The mean FF of the vertebra having fracture (69.19 ± 7.73%) was significantly higher than that of patients without fracture (57.96 ± 5.75%) ( p = 0.03). Taking a cutoff value of vertebral marrow FF of 54.85, the sensitivity and specificity of diagnosing osteoporosis were 93 and 80%, respectively, with a confidence interval of 95%. The area under the curve was 0.925. Conclusion Increased vertebral marrow FF is noted in the osteoporotic spine. FF has an inverse correlation with the T-score obtained from BMD. MRI with FF measurement can provide indirect evidence of osteoporosis, which can be done under one roof, especially in young patients where we need to avoid ionizing radiation.

A narrative review of percutaneous laser disc decompression - early experience in Lagos, Nigeria

Overview. Managing chronic pain arising from the degenerative disc disease of the spine has remained a huge challenge while choosing from within a vast array of treatment armamentarium ranging from the use of medications only or in combination with other physical treatment options, minimally invasive heat therapy, and operative interventions. Patients with chronic pain referred to as ‘contained disc’ in cervical, thoracic, and lumbar disc pathology have been successfully managed with percutaneous laser disc ablative therapy. This approach is only for selected patients and advantages derivable from this approach are the preservation of soft tissue anatomy, minimal post-procedure pain, less metabolic responses, and no blood loss when compared to open surgical procedures. Methodology. This is a one-year retrospective narrative study of six adult patients who presented with chronic low back pain related to the spine and had a lumbosacral spine magnetic resonance imaging (MRI) scan with findings of contained disc herniation. Patients’ brief clinical evaluation which involves biodata, history of pain, and pain scores using the visual analogue scale (VAS) pre and post-intervention and Oswestry disability index to assess disability from chronic pain. A narration of these patient’s progression to follow-up six months after the procedure was documented. Results. The results showed significant improvement in the VAS and ODI scores in five of the 6 patients, with one showing marginal improvement. Conclusion. Percutaneous lumbar disc decompression is effective in the management of chronic low back with concordant clinical and radiological evidence of contained disc pathology.

Prevalence and abnormalities of intervertebral discs (ivd) at various levels in lumbosacral spine magnetic resonance imaging (mri)

Abstract Objectives: To use magnetic resonance imaging to identify the prevalence and various abnormalities inside the intervertebral disc at different levels in the lumbosacral spine. Methodology: Cross-sectional study was conducted in the Radiology Department of Hayatabad Medical Complex Peshawar, Pakistan for six months from January 2023 to June 2023. Patients with Intervertebral disc abnormalities were scanned using standard protocol sagittal T1WI, T2WI, T2W STIR, T2W myelo, and in axial T1WI and T2WI. SPSS version 26 was used for data analysis. Tests of significance were applied and a p-value less than or equal to 0.05 was taken as significant. Results: The most frequently affected levels were L4-L5 and L5-S1, with single-site engagement being 30.0% and multi-site involvement being 69.9%. Numbness was 69.9%, Tingling 30.0%, herniated nucleus pulposus 30%, Protrusion 23.5%, Extrusion 6%, Posterolateral 2.7%, Posterocentral 26.2%, Foraminal 3.1%, Canal stenosis (mild 42.2%, moderate 63.2%, severe 5.5%, Thecal sac 36.4%, Lateral recess 55.5%, Foramen 20.1%, Multiple locations 8.3%, Diffuse disc bulge 96.4% (most common on L4-S1), Asymmetric disc bulge 2.4% and Modic changes 21.1% (grade-I 4.2%, grade-II 15.5%, grade-III 1.4%). Ligamentum flavum hypertrophy was at 20.1%, Facet joint hypertrophy at 22%, High-intensity zone (HIZ) at 29.4%, and Annular tear at 26.8% were all abnormalities that were frequently found on the L4-L5 level. Conclusion: Middle-aged persons are at increased risk, females and older individuals showed higher Intervertebral disc abnormalities, and L4-L5 and L5-S1 are the two most afflicted regions. Keywords: [Annular tear, Disc Bulge, High-Intensity zone, Lumbosacral spine, Modic Changes]

The Role of Magnetic Resonance Imaging in the Diagnosis of Spinal Dumbell Neurofibromatosis: A Case Report from a Specialist Hospital in Port Harcourt

Neurofibromatosis occurring in the spine also known as spinal neurofibromatosis (SNF) is a rare disease entity and they occur either unilaterally or bilaterally at the spinal roots. The low prevalence rate of the disease and scarcity of previous literatures is the main aim for this report.&#x0D; Our case study is a 29-years-old lady who presented to the Radiology department for a lumbosacral spine MRI, on account of both lower limb weakness, paresthesia, unsteady gait and finally inability to walk. The symptoms have been there since she was 14 years (15 years of progressive symptoms). She also presented with multiple macules on the skin (café au lait spots). Magnetic Resonance Imaging (MRI) of the lumbosacral spine revealed bilateral spinal neurofibromas at the spinal roots of the fourth lumbar vertebra to the sacral/coccygeal vertebrae with destruction of the sacro-coccygeal bones. MRI of the brain revealed no abnormalities in the brain and optic tract. The patient fulfilled the National Institutes of Health (NIH) criteria and that of revised diagnostic criteria for Neurofibromatosis (NF1).&#x0D; The patient also presented with lack of pain which could be due to impairment in sensory neurons. We describe a case of spinal neurofibromatosis diagnosed by MRI in a young lady with progressive lower limb weakness, paresthesia, sensory loss, café-au- lait spots and paraplegia.

Dissecting a radiculomedullary artery as an infrequent cause of low back pain: illustrative case.

There is currently no case described in the literature of epidural hematoma associated with subarachnoid hemorrhage due to dissection of a spontaneous radiculomedullary artery at the lumbar level and therefore its incidence and prevalence are not known. However, its etiology is thought to be similar and may not be diagnosed given its nonspecific symptomatology. The authors present the case of an adult patient who consulted the emergency department for 2 weeks of low back pain. On physical examination there were negative signs of radiculopathy without neurological focalization. The patient was evaluated by neurosurgery via thoracic and lumbosacral spine magnetic resonance imaging, with findings of epidural hematoma associated with subarachnoid hemorrhage in the lumbosacral region. After that, panangiography was done. In the study, it was possible to visualize a dissection of the radicular artery at the L2 level. The patient was not a candidate for surgical management and continued with medical pain management. The patient has a good clinical evolution and was discharged. The aim of the present case is to describe a unique case of radiculomedullary artery dissection as a cause of spontaneous epidural hematoma associated with a subarachnoid hemorrhage in the lumbar region.

Lumber Spine Incidental Findings During Discopathy Evaluation Using MRI

Magnetic Resonance Imaging (MRI) of the lumbar spine with the standard protocol can be useful in the diagnosis of incidental extraspinal lesions. The study aims to find the frequency and types of incidental findings (IF)of lumbosacral spine MRI in adult patients with suspected discopathy. It was a prospective analytical study involving MRI scans performed on a group of 50 patients (22 males and 28 females) in the age range of 25-85 years old reporting clinically chronic back pain without a histo

Prevalence and clinical potential of extraspinal incidental findings in lumbosacral spine MRI of patients with suspected disc diseases

BACKGROUND Incidental findings could be observed in organs close to the spine while reporting lumbosacral spine magnetic resonance imaging (MRI). This study aimed to report the prevalence and clinical potential of extraspinal incidental findings in lumbosacral MRI of patients with suspected disc diseases.&#x0D; METHODS This single-centered cross-sectional study was carried out on 420 consecutive adult patients who underwent lumbar spine MRI for suspected disc disease from January to July 2019. The MRI was checked for the presence of extraspinal incidental findings, and each finding was categorized according to the body organ and its clinical significance. Each MRI plane that best displayed the findings was recorded, and the association between the findings and patient's age and sex was determined.&#x0D; RESULTS Of 420 samples, 135 cases showed extraspinal findings (32.1%), and 7.6% of the patients displayed suspicious lesions. The urinary tract was the most common system (18.6%) to display both clinically significant (5.0%) and benign findings (13.6%), and the axial MRI section was the plane which showed most of the incidental findings. Incidental findings in any body system were rarely found in the younger patients. Females had significantly higher benign findings than males (p = 0.002).&#x0D; CONCLUSIONS The prevalence of extraspinal findings in lumbosacral spine MRI is high, and some are significant. Most findings are related to the urinary tract and best displayed in the axial plane.

Closed spinal dysraphism in a 6-month-old mixed breed dog

The term spinal dysraphism defines an incomplete fusion or a bone defect that affects the neural structures of the spinal cord due to a neural tube malformation. A 6-month-old, male, mixed-breed dog, was evaluated for paraparesis, pelvic limb proprioceptive ataxia, faecal and urinary incontinence. A neurological examination indicated an L4-S3 spinal cord segment lesion. A thoracolumbar and lumbosacral spine magnetic resonance imaging was performed and a closed spinal dysraphism, with the presence of a lipomyelomeningocele, was detected. The magnetic resonance imaging showed an entire narrowing passage and a fibrous mass stemming from a wedge-shaped gap in the caudal region of the dorsal lamina of the L4 vertebra, leaving the spinal canal towards the skin surface in the region where the skin stigma was observed. A dorsal laminectomy was performed, the spinal cord was exposed, and the entire fibrous mass was excised. Three months postoperatively, the patient had a complete resolution of the urinary and faecal incontinence showing only a residual mild paraparesis, which remained six months after surgery. The surgical procedure resulted in the satisfactory recovery of the neurological signs.

IMAGE CORRELATION BETWEEN FACET EFFUSION AND LUMBAR INSTABILITY

ABSTRACT Objective To assess the incidence of facet effusion in lumbosacral spine magnetic resonance imaging (MRI) and the relationship with radiographic segmental instability in patients submitted to spinal surgery. Methods Retrospective cohort study of patients submitted to lumbosacral spine surgery over a period of three years, through the evaluation of dynamic radiographs (X-ray) motion and facet effusion in axial section of MRI. Instability was defined as vertebral translation &gt; 3 mm or intervertebral angle &gt; 10º, and facet effusion as fluid in the facet joints &gt; 1.5 mm. Results The total number of patients that fulfilled the criteria for analysis was 244, of which 47 presented movement (≤ 3 mm) and 31 presented excessive movement (&gt; 3 mm), 115 had facet effusion (≤ 1.5 mm) and 46 presented excessive fluid (&gt; 1.5 mm). Statistical analysis did not demonstrate a significant association between increased segmental movement and facet effusion (p = 0.150). Conclusions The total incidence of facet effusion was 47.1% and the excessive fluid was 18.9%.There was no association between facet effusion in MRI and instability in dynamic X-ray. MRI does not replace dynamic X-ray in flexion and extension in the evaluations of lumbar instability. Level of evidence III; Retrospective Cohort.

Incidental findings on magnetic resonance imaging of lumbosacral spine in patients with back pain and/orradiculopathy

Background and objective: An incidental lesion is an asymptomatic lesion found while examining a patient for an unrelated reason. Lumbar spine imaging may reveal either clinically insignificant spine incidental abnormalities and/or extra-spinal Incidental finding that, at times, may even explain the patient’s symptoms. This study aimed to evaluate the frequency and types of incidental findings in lumbosacral magnetic resonance examination and to find the correlation between the frequency distribution of findings in terms of age and sex. Methods: This cross-sectional study involved 1250 persons who were referred for lumbosacral spine magnetic resonance imaging because of low back pain and/or radiculopathy. The magnetic resonance images were viewed to evaluate the frequency of incidental findings which were divided into extra and intraspinal findings. Results: Incidental findings were noted in 332 (26.6%) patients of the 1250 comprising 94 (28.3%) males and 238(71.7%) females. Some of them had more than one incidental finding. Cortical and para pelvic renal cysts were the most common extra spinal incidental findings, while vertebral hemangioma was the most common intraspinal incidental finding. Conclusion: Incidental findings were common in magnetic resonance imaging examination of the lumbar spine, and most were clinically insignificant; however some of these findings may be more significant than the spinal problems being evaluated and can have a significant impact on patient management. Therefore, they should be included in the reports since they will give additional and valuable information.

Intradural Intramedullary Teratoma Presenting in the Lumbar Spine: Report of a Rare Case

Intradural teratomas are an exceedingly unusual phenomenon. They are tumors with the cellular constituent source of all the 3 germ cell layers. We here report a case of an 18-year-old man with special pathologic features. There was no history of spinal dysraphism, congenital spinal abnormalities, previous spinal surgery, or lumbar puncture. Lumbosacral spine magnetic resonance imaging revealed a well-delineated, intramedullary mass at the L2-3 level. Histopathology examination of the resected tumor revealed cystic spaces lined with simple columnar epithelium as well as mucus secreting epithelium, adipose tissue, salivary gland-like serous cells, and bundles of smooth muscle cells. We have seen unusual histopathologic features in the case, for example, there were no cartilage components that are mostly found in mature teratomas, abundant Pacinian corpuscle nerve endings, and nerve trunks. There were no immature elements or malignant cells. Teratomas should be taken into consideration in the differential diagnosis of intramedullary lesions, even after the imaging reveals tissue homogeneity.

Hybrid Bone Single Photon Emission Computed Tomography Imaging in Evaluation of Chronic Low Back Pain: Correlation with Modic Changes and Degenerative Disc Disease.

Multiple radiologic modalities are used in the evaluation of patients with low back pain (LBP). Only limited evidence currently exists to support the use of bone hydroxydiphosphonate single photon emission computed tomography (SPECT/CT) in patients with Modic changes (MCs) and degenerative disc disease. The aim of this study was to assess the value of the hybrid bone SPECT/CT imaging in patients with chronic LBP. We evaluate the correlation of hybrid bone SPECT/CT imaging patterns with MCs and disc abnormalities on magnetic resonance imaging (MRI). This was a prospective study. Ninety-nine consecutive patients with LBP from a single center. The degree of lumbar intervertebral disc and endplate degeneration on MRI and osteoblastic activity was shown on SPECT/CT. These 99 consecutive patients with LBP were prospectively evaluated. Patients with contemporary lumbosacral spine MRI and bone SPECT/CT were included. Patients with known or suspected malignancy, trauma, infectious processes, and previous surgery were excluded. The effect of LBP on the daily quality of life was assessed using Oswestry disability index. We analyzed the correlation between the degenerative changes at the intervertebral disc spaces and endplates on MRI and bone SPECT/CT findings using receiver operating characteristic curve analysis and Kappa statistics. The Pfirrmann grading system was used to score the severity of disc space degeneration on MRI scans. A total of 99 patients were included in the study (58 women, 41 men; mean age, 56.2 years). Mean Oswestry disability index score was 38.5% (range, 8%-72%). The L2-3 through to L5-S1 levels were studied. MCs were found in 54% of patients. Of the 396 levels examined 85 were found to have MCs (21.5%). The most affected levels were L4-5 (31.3%) and L5-S1 (40.9%). Pfirrmann grade 5 disc space (72.9%) was associated with MC (Pp<0.001). MC (70.6%) and Pfirrmann grade 5 disc spaces (73%) resulted in scintigraphically active endplate/disc space on SPECT/CT (P< 0.001). Bone SPECT/CT showed high metabolic activity in 96.1% of endplates with MC type I, 56% with MC type II, and 77.8% with MC type III. In this study we found a high agreement between MCs and increased metabolic activity on bone SPECT/CT imaging. MC type 1 and Pfirrmann grade 5 were the best binary predictors for positivity on bone SPECT/CT and had equivalent correlations. Lower vertebral levels in the lumbar spine were associated with higher degree of disc degeneration, high frequency of MCs, and positivity on bone SPECT/CT.

Tarlov Cyst Is Correlated with a Short Broad Terminal of the Thecal Sac.

Background In clinical practice, we noted that the end section of the thecal sac is apparently different in patients with Tarlov cyst compared with that of the normal population. We conducted this clinical study based on magnetic resonance imaging (MRI). Methods Our study included 30 patients with Tarlov cyst and 30 healthy volunteers as the control. The L4, L5 cross-section areas, the L4, L5 anteroposterior diameters, and the terminal length of the thecal sac were measured from the lumbosacral spine MRI. Results The L4, L5 cross-section areas and the L4, L5 anteroposterior diameters are larger for the Tarlov cyst patients than the controls, but the terminal length of the thecal sac is shorter. Conclusion The Tarlov cyst is correlated with a short broad end of the thecal sac. Possibly, this anatomical variant is a causative factor of Tarlov cyst.

Post-procedure adhesive arachnoiditis following obstetric spinal anaesthesia.

Sir, Adhesive arachnoiditis is a crippling disorder in which the pia-arachnoid undergoes extensive inflammatory reactions to injurious stimulus, resulting in subarachnoid scarring. A Swedish study reports the incidence of neurological complications as one case per 2834 subarachnoid blocks and at least one permanent damage for every 923 epidural blocks.[1] A Finnish study reports an incidence of serious complications as 0.45/10,000 for intrathecal and 0.52/10,000 for epidural blocks.[2] A 35-year-old mother with no significant medical history, in her second pregnancy, underwent spinal anaesthesia for an elective caesarean section at 40 weeks gestation at another hospital. As per the information obtained, spinal anaesthesia in sitting position was performed with due aseptic precautions in L2-L3 interspace using 10% povidone-iodine (betadine™) solution. The cerebrospinal fluid (CSF) tap could be obtained on the second attempt. After aspiration of clear, free-flowing CSF, 12 mg of 0.5% hyperbaric bupivacaine was administered. Surgery proceeded uneventfully. On the second post-operative day, on the removal of the urinary catheter, the patient complained of urinary incontinence with the loss of sensation over the perineal area and buttocks. Gradually she also complained of constipation, following which an enema was given on the fourth post-operative day. She passed stool but, subsequently, lost her bowel control too. The patient was referred 11 days post-partum to our centre with signs of S2-S4 radiculopathy, urinary retention, constipation with faecal impaction, loss of sensation over buttocks and perineal area with weak perianal reflex. All her records from the previous hospital were obtained. A thorough examination demonstrated localised unilateral right-sided sensory loss over T11-T12 dermatome. The rectum was hugely loaded with faecal matter. A lumbosacral spine magnetic resonance imaging (MRI) [Figure 1] showed thickening, clumping and nodular enhancement of cauda equina nerve roots, suggestive of arachnoiditis. CSF analysis showed mild lymphocytosis.Figure 1: Axial magnetic resonance imaging of lumbosacral spine T2 weighted, the arrow showing thickening, clumping and nodular enhancement of cauda equina nerve roots-suggestive of arachnoiditis (likely post-surgery/procedure)A neurosurgical opinion was taken and the patient was put on a short course of steroids (tablet deflazacort six mg thrice daily). She was asked to undergo physiotherapy and was also suggested transcutaneous electrical nerve stimulation therapy. The patient was discharged to a rehabilitation centre where she received oral methylprednisolone 16 mg once daily for 7 weeks with gabapentin 100 mg thrice daily for 3 weeks. A repeat MRI 2 months later showed mild enhancement of cauda, clumping of root and resolution compared to the previous MRI. The patient was advised pelvic floor exercises with dietary adjustments to control the faecal incontinence. Steroids were tapered over 2 months after reviewing her 30 days later. She was advised to remove catheter under medical guidance and watch for retention and bladder sensation. At 12 months follow-up, the patient has significantly regained her bladder control. There was still considerable impairment in bowel control. The anal tone had not completely resolved till the date of submission of this manuscript. Contamination of intrathecal local anaesthetic drugs with noxious chemicals has been widely suggested as an aetiology in cases of adhesive arachnoiditis; phenolic, acidic and detergent contaminants all being known neurotoxic agents.[34] Alcoholic chlorhexidine, in 2008, was the identified as a culprit in a case of arachnoiditis in a trial held at the United Kingdom.[5] We considered povidone-iodine contamination as a possibility in this case, by contamination of the injectate or improper cleaning of povidone iodine from the skin before proceeding with the subarachnoid block. Without more definitive data, neuraxial blocks should be done under stringent aseptic, atraumatic techniques after discarding all sources of contamination. It also seems pertinent to explain to patients the risks of late, permanent neurological deficit while obtaining informed consent. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgement This case study was supported by the entire Department of Anaesthesiology and Intensive Care Medicine, B. R. Singh Hospital, Eastern Railway, Kolkata. We are also thankful to the Department of Gynaecology and Obstetrics, B. R. Singh hospital, the nursing staff and attendants for the support in patient care and to the patient and her family for giving consent to proceed with submission for publication of the report.

Detection of numeric and morphological variation at lumbosacral junction: Role of whole spine magnetic resonance imaging

Introduction: Numeric variation in presacral vertebral segments and lumbosacral transitions has been reported in different studies with wide range of prevalence (4-36%). There is no standard method for numbering of lumbar vertebrae. In typical regional sequences for lumbar spine magnetic resonance imaging (MRI), vertebral and disc morphology, intervertebral angle, and various local anatomical structures are used as landmarks for numbering. Aim: (a) To document the prevalence in variation of presacral mobile vertebral count and lumbosacral vertebral transition using whole spine MRI. (b) To evaluate the accuracy in the location of the proximal right renal artery (RRA), aortic bifurcation, and conus termination as a landmark for vertebral numbering. Materials and Methods: This prospective observational study includes 317 patients, referred for MRI of the lumbosacral spine. Vertebrae were counted manually using sagittal whole spine localizer images (Mobi View). Short tau inversion recovery (STIR) coronal images were included for classification of lumbosacral transitional vertebrae (LSTV). Prevalence and types of LSTV and level of proximal RRA, aortic bifurcation, and conus termination were documented. Results: About 25.5% of patients showed LSTV and 7.8% of patients showed variation in presacral vertebral count without LSTV. Castellvi Type IIIb LSTV was most prevalent followed by Type IIb. There was significant variation in the level of aortic bifurcation, RRA, and conus termination in patients with normal count and with LSTV. Conclusions: Spinal and paraspinal structures, such as aortic bifurcation, RRA, and conus termination, cannot be considered as landmark for numbering of vertebrae. Counting of vertebrae manually from C2 is recommended for confident documentation of numerical variation in vertebrae. The inclusion of STIR coronal image helps in better identification and characterization of the LSTV.

Patterns of Care After Magnetic Resonance Imaging of the Spine in Primary Care

Retrospective cohort study. To examine health care services use after a magnetic resonance imaging (MRI) scan of the lumbosacral or cervical spine ordered by a primary care physician. The use of MRI of the spine in the primary care setting is increasing, yet little is known about the relationship between MRI scan findings and subsequent patterns of health care utilization. Linkage of records from an audit of outpatient MRI scans of the spine performed in Ontario, Canada, to administrative databases. Of the 647 patients who had a lumbosacral spine MRI scan ordered by a primary care physician, 288 (44.5%) were seen in consultation by an orthopedic surgeon or neurosurgeon, and 42 (6.5%) received spine surgery during 3 years of follow-up. Of the 373 patients who had a cervical spine MRI scan ordered by a primary care physician, 164 (44.0%) were seen in consultation by an orthopedic surgeon or neurosurgeon, and none had spine surgery during 3 years of follow-up. Patients with severe disc herniation (likelihood ratio, 5.62, 95% confidence interval, 2.64-12.00) or severe spinal stenosis (likelihood ratio, 2.34; 95% confidence interval, 1.13-4.85) on lumbosacral spine MRI were more likely to undergo subsequent surgery. However, many patients with these MRI abnormalities did not receive surgery, and the absence of these MRI findings did not significantly lower the likelihood of subsequent surgery. Patients receiving MRI scans of the spine in the primary care setting are frequently referred for surgical assessment and most do not receive subsequent surgery. MRI scan results do not discriminate very well between those who will and will not undergo surgery, suggesting that alternative models for the assessment of patients with spinal complaints in primary care should be explored, particularly in jurisdictions with long wait times for elective spinal surgery consultation.

Magnetic Resonance Imaging vs. Electrodiagnostic Root Compromise in Lumbar Spinal Stenosis

The high false-positive rate of magnetic resonance imaging (MRI) makes it a less-than-reliable tool for evaluating clinically significant stenosis. Finding MRI changes that correlate with electrodiagnostic abnormalities might lead to more successful treatment decision making. The purpose of this study was to identify MRI changes that correlate with neurologic abnormalities measured by electrodiagnosis in patients with spinal stenosis. One hundred fifty persons with and without back pain between the ages of 55 and 79 yrs participated in this prospective, blinded, controlled study. Exclusion criteria included previous spine surgery or known neuropathy. Needle electromyography of the limb, nerve conduction studies, including peroneal F-wave and tibial H-wave, and noncontrast lumbo-sacral spine MRI were completed. A codified physical medicine and rehabilitation history and physical examination was completed to differentiate symptomatic lumbar stenosis patients from asymptomatic controls. The relationship between lumbar MRI measurements and extremity electromyography findings was studied. MRI measurements did not differ significantly with respect to extremity needle electromyography findings in the entire population or in patients with clinical signs of lumbar stenosis. In the entire population, an absent tibial H-wave corresponded to the interfacet ligament distance at L5-S1 and anterior to posterior canal size at L4-5. In patients clinically evaluated as having lumbar stenosis, peroneal F-wave latency correlated with anteroposterior canal size at L4-5 and interfacet ligament and anterior to posterior lateral recess narrowing at L5-S1. In patients with clinical signs and symptoms of lumbar stenosis, limb electromyography findings did not correlate with MRI measurements, although H-wave and F-wave testing correlated with relevant locations of stenosis. Needle electromyography does not differentiate patients with symptomatic mild or moderate lumbar stenosis. However, H-wave and F-wave correlated to specific anatomical changes on MRI in this patient population.