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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 57

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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 57. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Degenerative Lumbar Spondylosis Chapter 20 549 Imaging Studies Debate continues about the need for standard radiographs for the initial evaluation of patients with predominant back pain. MRI has become the imaging modality of choice in evaluating LBP patients. However lumbosacral transitional anomalies can be missed when only sagittal and axial views are obtained. In our center we only omit standard radiographs in the presence of recent anteroposterior and lateral radiographs. A detailed description of the imaging modalities for the lumbar spine is included in Chapter 9 . Standard Radiographs Standard radiographs are helpful in diagnosing lumbosacral transitional anomalies which may be overlooked on MRI in cases without coronal sequences. Standard radiographs are rarely helpful in reliably identifying the pain source. However non-specific findings indicating a painful disc degeneration or facet joint osteoarthritis are disc space narrowing with endplate sclerosis severe facet joint osteoarthritis Standard radiographs are rarely diagnostic Flexion Extension Films Functional views are generally regarded as unreliable for the diagnosis of a segmental instability because of the wide range of normal motion 248 . However excessive segmental motion 4 mm or subluxation of the facet j oint that is rare in asymptomatic individuals and is not even observed in patients who exhibit extreme ranges of motion e.g. contortionists 120 . However the inability to reliably diagnose or attribute segmental instability to a specific level by imaging studies prompts the taking of great care with this diagnostic label Case Study 2 . Flexion extension views cannot reliably distinguish between normal and symptomatic lumbar motion Magnetic Resonance Imaging MRI has surpassed computed tomography CT because of its tissue contrast and multiplanar capabilities. MRI is a very sensitive but less specific imaging modality because of the vast majority of alterations which can be observed in .