Should I order a Magnetic Resonance Imaging (MRI) of the lumbar spine?

MRI Lumbar Spine is Appropriate for Degenerative Disc Disease with Multilevel Narrowing

MRI of the lumbar spine without IV contrast is usually appropriate for your case of degenerative disc disease with multilevel narrowing, facet joint hypertrophy, and osteophytes at multiple levels.

Rationale for MRI Lumbar Spine

• Your radiographic findings show dexterous scoliosis in the thoracolumbar region with narrowing of L3-L4, L4-L5, and L5-S1 intervertebral spaces, anterior and lateral osteophytes, and facet joint hypertrophy at multiple levels, which represent subacute or chronic degenerative changes that warrant further evaluation 1
• MRI lumbar spine without IV contrast is the preferred imaging modality for patients with subacute or chronic low back pain with persistent or progressive symptoms, especially when there is evidence of multilevel disc narrowing and facet joint hypertrophy 1
• MRI provides excellent soft-tissue contrast and accurately depicts lumbar pathology, including disc degeneration, as well as visualization of the thecal sac and neural structures that cannot be adequately assessed with plain radiographs 2

Clinical Considerations

• The American College of Radiology (ACR) recommends MRI lumbar spine without IV contrast as the initial advanced imaging for patients with subacute or chronic low back pain who have persistent symptoms during or following conservative management 1
• Your findings of multilevel disc space narrowing (L3-L4, L4-L5, L5-S1) and facet joint hypertrophy suggest potential nerve root compression or spinal stenosis that should be further evaluated with MRI 1, 3
• MRI is highly sensitive for detecting disc degeneration, disc herniation, spinal stenosis, and nerve root compression that may be contributing to your symptoms 2, 4

Benefits of MRI Over Other Modalities

• MRI provides superior soft tissue contrast compared to CT, allowing better visualization of neural structures, ligaments, and discs 2
• MRI does not involve radiation exposure, making it safer than CT for evaluation of degenerative spine conditions 1
• MRI can detect bone marrow abnormalities and subtle changes in disc hydration that cannot be seen on CT or plain radiographs 4, 5

When to Consider Alternative Imaging

• If MRI is contraindicated (e.g., non-MRI compatible implants, severe claustrophobia), CT myelography would be an appropriate alternative 1, 6
• CT myelography can be useful in assessing the patency of the spinal canal/thecal sac and neural foramina but has the disadvantage of requiring lumbar puncture for intrathecal contrast injection 1
• Standard CT without contrast can be considered if the primary concern is bony detail, but it is inferior to MRI for evaluation of soft tissues and neural structures 1

Imaging Protocol Considerations

• T1-weighted and T2-weighted sagittal images, along with T2-weighted axial images, should be obtained for comprehensive evaluation of the lumbar spine 4
• Axial images are particularly important for evaluating the neural foramina and potential nerve root compression that may be present with your multilevel disc narrowing 4, 3
• In some cases, weight-bearing or axial-loaded MRI may provide additional information about dynamic stenosis that might not be apparent on standard supine MRI 7

MRI lumbar spine without IV contrast is the most appropriate next step in your case to fully evaluate the extent of degenerative changes and their potential impact on neural structures, which will guide further management decisions 1.