MRI Lumbar Spine Description Components
A comprehensive MRI lumbar spine description should include assessment of disc morphology, neural structures, bone marrow signal, and adjacent soft tissues, with specific attention to pathological findings that may impact patient morbidity, mortality, or quality of life. 1, 2
Essential Components of Lumbar Spine MRI Description
Vertebral Bodies and Alignment
- Vertebral body height, alignment, and signal intensity
- Presence of fractures, compression, or abnormal curvature
- Bone marrow signal abnormalities (edema, replacement)
- Endplate changes (Modic changes)
- Transitional anatomy if present
Intervertebral Discs
- Disc height and hydration status
- Pfirrmann grading of disc degeneration 3
- Disc contour abnormalities:
- Normal
- Bulging
- Protrusion
- Extrusion
- Sequestration
- High-intensity zones (HIZ) in the annulus fibrosus
Spinal Canal and Neural Elements
- Thecal sac dimensions and contour
- Central canal patency/stenosis
- Cauda equina appearance and position
- Nerve root visualization and compression
- Presence of synovial cysts or other space-occupying lesions
Neural Foramina and Lateral Recesses
- Patency of neural foramina at each level
- Presence and degree of foraminal stenosis
- Lateral recess dimensions and potential nerve impingement
Facet Joints and Posterior Elements
- Facet joint alignment and arthrosis
- Ligamentum flavum thickness
- Pars interarticularis integrity (for spondylolysis)
- Spinous process and lamina evaluation
Paraspinal Soft Tissues
- Paraspinal muscle appearance
- Presence of edema, atrophy, or fatty infiltration
- Abnormal fluid collections or masses
Post-contrast Findings (when applicable)
- Enhancement patterns of discs, vertebrae, or soft tissues
- Differentiation between recurrent disc herniation and post-surgical scarring
- Identification of infectious or neoplastic processes 2
Special Considerations
Infection Assessment
When infection is suspected, the description should include:
- Presence of discitis/osteomyelitis
- Epidural abscess or phlegmon
- Paraspinal extension of infection
- Enhancement patterns after contrast administration 1
Post-surgical Evaluation
For patients with prior surgery:
- Hardware position and integrity
- Evidence of fusion or pseudarthrosis
- Differentiation between scar tissue and recurrent disc herniation
- Adjacent segment degeneration 2
Neoplastic Conditions
When malignancy is suspected:
- Bone marrow signal abnormalities
- Soft tissue masses
- Epidural extension
- Enhancement characteristics 1, 2
Common Pitfalls to Avoid
Over-interpretation of common degenerative findings - bulging discs and disc protrusions are present in up to 67% of asymptomatic individuals 4
Failure to correlate imaging findings with clinical presentation - many MRI abnormalities have poor correlation with symptoms 5
Inadequate description of neural compression - specify the exact location and severity of stenosis or nerve root impingement
Missing subtle findings that may indicate serious pathology (e.g., small epidural collections in infection, subtle marrow signal changes in early malignancy)
Incomplete assessment of all visualized structures, including abdominal and pelvic organs partially included in the field of view
By systematically addressing these components, the MRI description provides clinically relevant information that guides appropriate management decisions and improves patient outcomes.