Imaging

Lumbar Disc Herniation

Preliminary Diagnosis: Lumbar Disc Herniation

I. What imaging technique is first-line for this diagnosis

  • Noncontrasted extradural protocol MR of the lumbar spine in patients without a history of prior back surgery

  • In patients with prior back surgery, the first line for diagnosis is contrasted extradural protocol MR of lumbar spine

II. Describe the advantages and disadvantages of this technique for diagnosis of lumbar disc herniation.

Advantages

  • The patient is not exposed to ionizing radiation.

  • Contrasted MR examinations are able to differentiate granulation tissue from recurrent disc.

Disadvantages

  • Expensive

  • Time-consuming

  • Requires significant patient cooperation to minimize motion artifact

III. What are the contraindications for the first-line imaging technique?

  • Patients who contain non-MR compatible hardware

IV. What alternative imaging techniques are available?

  • CT myelography

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of lumbar disc herniation.

CT myelography

Advantages

  • May be performed in patients with non-MR compatible hardware

  • May be performed much faster than MR exams

Disadvantages

  • Exposes the patient to ionizing radiation

VI. What are the contraindications for the alternative imaging techniques?

CT myelography

  • Patients allergic to iodinated contrast

  • Relative contraindication for patients with renal failure

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