Lumbar Spine MRI - Overview & Technique

• MRI of the lumbar spine is a type of medical imaging procedure which is performed by taking axial, coronal, and sagittal images of the lumbar spine usually from the L1 level to the S1 level.  This give exquisite characterization of the bones, ligaments, intervertebral discs, prevertebral soft tissues, and posterior paraspinal muscles.  We obtain very good details of the spinal cord and exiting nerve roots.
• MRI scans are interpreted by radiologists in an outpatient imaging center, hospital, or via teleradiology.
• Spine MRI including MRI of the lumbar spine, thoracic spine, and cervical spine are among the most commonly performed procedures at MRI centers.

Lumbar Spine MRI - Alternative Names and Explanations

MRI of the lumbar spine, magnetic resonance imaging of the lumbar spine, MR imaging of the lumbar spine, lumbar spine magnetic resonance imaging, lspine mri, l-spine mri, l-spine magnetic resonance imaging, MRI Lumbar Spine w/o contrast CPT Code 72148, MRI Lumbar Spine with & w/o contrast CPT Code 72158

Lumbar Spine MRI - Benefits vs. Other Tests

• Magnetic resonance imaging (MRI) is a medical imaging technique used to visualize the structure and function of the body providing greater contrast between the different soft tissues of the body than does computed tomography scans (CT Scan). It is especially useful for the musculoskeletal system.
• MRI has greater contrast resolution that CT for the soft tissues such as the intervertebral discs and nerve roots which exits the neural foramina.
• MRI better evaluates soft tissue structures such as the spinal cord that CT
• MRI has better 3D visualization than x-rays.
• MRI is more sensitive for bony lesions than X-ray, CT, and sometimes PET scans.
• Xrays can visualize the bones, soft tissues, and alignment, but MRI is superior for small changes in alignment and non-displaced fractures.
• CT scans of the lumbar spine are very sensitive for spondylolysis (fractures) but CAT scans are inferior for evaluation of the nerves and discs.
• Nuclear medicine studies such as bone scans (sodium fluoride using PET or Tc-MDP using SPECT) are good for evaluation of the bones scanning with MRI is superior for the non-skeletal structures.
• X-rays are not as sensitive for visualizing the retroperitoneal structures and the muscles and ligaments surrounding the bones.  Although the are cheaper they are not as precise.

MRI of the Lumbar Spine - Indications, Common Uses, & Positive Findings

• Neurologic deficits, evidence of radiculopathy, acute spinal cord compression (e.g., sudden bowel/bladder disturbance)
• Suspected systemic disorders (primary tumors, drop metastases, osteomyelitis)
• Postoperative evaluation of lumbar spine: disk vs. scar
• Localized back pain with no radiculopathy (leg pain)
• Disc Extrusion
• Disc herniations
• Disc protrusions
• Nerve root compression
• Spondylolysis:  fracture of the spine

MRI Lumbar Spine - Images

Above is an MRI scan of the lumbar spine using T2 weighting and shows the normal lumbar curvature.  The vertebral bodies, discs, spinal cord, CSF fluid, and posterior paraspinal muscles are normal.  There are no bony lesions or fractures.

MRI Lumbar Spine - References, Links, and Additional Information

Lumbar spine MRI information including overview, technique, alternatives, benefits, and common findings.  Schedule an MRI of the lumbar spine in Los Angeles, Beverly Hills, or Glendale.

MRI of the lumbar spine, lumbar spine mri, lumbar mri, l-spine mri

• RadiologyInfo - Musculoskeletal MRI Page
• Teleradiology Services

Common causes of low back pain include lumbar strain, nerve irritation, lumbar radiculopathy, bony encroachment, and conditions of the bone and joints. Each of these is reviewed below.

Lumbar strain (acute, chronic)

A lumbar strain is a stretch injury to the ligaments, tendons, and/or muscles of the low back. The stretching incident results in microscopic tears of varying degrees in these tissues. Lumbar strain is considered one of the most common causes of low back pain. The injury can occur because of overuse, improper use, or trauma. Soft-tissue injury is commonly classified as "acute" if it has been present for days to weeks. If the strain lasts longer than three months, it is referred to as "chronic."

Lumbar strain most often occurs in people in their forties, but it can happen at any age. The condition is characterized by localized discomfort in the low back area with onset after an event that mechanically stressed the lumbar tissues. The severity of the injury ranges from mild to severe, depending on the degree of strain and resulting spasm of the muscles of the low back.

The diagnosis of lumbar strain is based on the history of injury, the location of the pain, and exclusion of nervous system injury. Usually, X-ray testing is only helpful to exclude bone abnormalities.

The treatment of lumbar strain consists of resting the back (to avoid reinjury), medications to relieve pain and muscle spasm, local heat applications, massage, and eventual (after the acute episode resolves) reconditioning exercises to strengthen the low back and abdominal muscles. Long periods of inactivity in bed are no longer promoted, as this treatment may actually slow recovery. Spinal manipulation for periods of up to one month has been found to be helpful in some patients who do not have signs of nerve irritation. Future injury is avoided by using back-protection techniques during activities and support devices as needed at home or work.

Nerve irritation

The nerves of the lumbar spine can be irritated by mechanical impingement or disease anywhere along their paths -- from their roots at the spinal cord to the skin surface. These conditions include lumbar disc disease (radiculopathy), bony encroachment, and inflammation of the nerves caused by a viral infection (shingles). See discussions of these conditions below.

Lumbar radiculopathy

Lumbar radiculopathy is nerve irritation that is caused by damage to the discs between the vertebrae. Damage to the disc occurs because of degeneration ("wear and tear") of the outer ring of the disc, traumatic injury, or both. As a result, the central softer portion of the disc can rupture (herniate) through the outer ring of the disc and abut the spinal cord or its nerves as they exit the bony spinal column. This rupture is what causes the commonly recognized "sciatica" pain that shoots down the leg. Sciatica can be preceded by a history of localized low-back aching or it can follow a "popping" sensation and be accompanied by numbness and tingling. The pain commonly increases with movements at the waist and can increase with coughing or sneezing. In more severe instances, sciatica can be accompanied by incontinence of the bladder and/or bowels.

Lumbar radiculopathy is suspected based on the above symptoms. Increased radiating pain when the lower extremity is lifted supports the diagnosis. Nerve testing (EMG/electromyogram and NCV/nerve conduction velocity) of the lower extremities can be used to detect nerve irritation. The actual disc herniation can be detected with imaging tests, such as CAT or MRI scanning.

Treatment of lumbar radiculopathy ranges from medical management to surgery. Medical management includes patient education, medications to relieve pain and muscle spasms, cortisone injection around the spinal cord (epidural injection), physical therapy (heat, massage, ultrasound, electrical stimulation), and rest (not strict bed rest, but avoiding reinjury). With unrelenting pain, severe impairment of function, or incontinence (which can indicate spinal cord irritation), surgery may be necessary. The operation performed depends on the overall status of the spine and the age and health of the patient. Procedures include removal of the herniated disc with laminotomy (a small hole in the bone of the lumbar spine surrounding the spinal cord), laminectomy (removal of the bony wall), by needle technique (percutaneous discectomy), disc-dissolving procedures (chemonucleolysis), and others.Picture of herniated disc between L4 and L5

Any condition that results in movement or growth of the vertebrae of the lumbar spine can limit the space (encroachment) for the adjacent spinal cord and nerves. Causes of bony encroachment of the spinal nerves include foraminal narrowing (narrowing of the portal through which the spinal nerve passes from the spinal column, out of the spinal canal to the body), spondylolisthesis (slippage of one vertebra relative to another), and spinal stenosis (compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal). Spinal-nerve compression in these conditions can lead to sciatica pain that radiates down the lower extremities. Spinal stenosis can cause lower-extremity pains that worsen with walking and are relieved by resting (mimicking the pains of poor circulation). Treatment of these afflictions varies, depending on their severity, and ranges from rest to surgical decompression by removing the bone that is compressing the nervous tissue.

Bone and joint conditions

Bone and joint conditions that lead to low back pain include those existing from birth (congenital), those that result from wear and tear (degenerative) or injury, and those that are due to inflammation of the joints (arthritis).

Congenital bone conditions -- Congenital causes (existing from birth) of low back pain include scoliosis and spina bifida. Scoliosis is a sideways (lateral) curvature of the spine that can be caused when one lower extremity is shorter than the other (functional scoliosis) or because of an abnormal architecture of the spine (structural scoliosis). Children who are significantly affected by structural scoliosis may require treatment with bracing and/or surgery to the spine. Adults infrequently are treated surgically but often benefit by support bracing.

Spina bifida is a birth defect in the bony vertebral arch over the spinal canal, often with absence of the spinous process. This birth defect most commonly affects the lowest lumbar vertebra and the top of the sacrum. Occasionally, there are abnormal tufts of hair on the skin of the involved area. Spina bifida can be a minor bony abnormality without symptoms. However, the condition can also be accompanied by serious nervous abnormalities of the lower extremities.

Degenerative bone and joint conditions -- As we age, the water and protein content of the body's cartilage changes. This change results in weaker, thinner, and more fragile cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). Degeneration of the disc is called spondylosis. Spondylosis can be noted on X-rays of the spine as a narrowing of the normal "disc space" between the vertebrae. It is the deterioration of the disc tissue that predisposes the disc to herniation and localized lumbar pain ("lumbago") in older patients. Degenerative arthritis (osteoarthritis) of the facet joints is also a cause of localized lumbar pain that can be detected with plain X-ray testing. These causes of degenerative back pain are usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasm, and inflammation.

Injury to the bones and joints -- Fractures (breakage of bone) of the lumbar spine and sacrum bone most commonly affect elderly people with osteoporosis, especially those who have taken long-term cortisone medication. For these individuals, occasionally even minimal stresses on the spine (such as bending to tie shoes) can lead to bone fracture. In this setting, the vertebra can collapse (vertebral compression fracture). The fracture causes an immediate onset of severe localized pain that can radiate around the waist in a band-like fashion and is made intensely worse with body motions. This pain generally does not radiate down the lower extremities. Vertebral fractures in younger patients occur only after severe trauma, such as from motor-vehicle accidents or a convulsive seizure. In both younger and older patients, vertebral fractures take weeks to heal with rest and pain relievers. Compression fractures of vertebrae associated with osteoporosis can also be treated with a procedure called vertebroplasty, which can help to reduce pain. In this procedure, a balloon is inflated in the compressed vertebra, often returning some of its lost height. Subsequently, a "cement" (methymethacrylate) is injected into the balloon and remains to retain the structure and height of the body of the vertebra.

Arthritis -- The spondyloarthropathies are inflammatory types of arthritis that can affect the lower back and sacroiliac joints. Examples of spondyloarthropathies include reactive arthritis (Reiter's disease), ankylosing spondylitis, psoriatic arthritis, and the arthritis of inflammatory bowel disease. Each of these diseases can lead to low back pain and stiffness, which is typically worse in the morning. These conditions usually begin in the second and third decades of life. They are treated with medications directed toward decreasing the inflammation. Newer biologic medications have been greatly successful in both quieting the disease and stopping its progression.

Your results will be read by a radiologist on-site or by a teleradiologist.

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