What type of Computed Tomography (CT) scan is ordered to evaluate lower back pain?

From the Guidelines

For evaluating lower back pain, an MRI of the lumbar spine is typically the initial imaging modality of choice, as it provides excellent soft-tissue contrast and accurately depicts lumbar pathology, including disc degeneration, as well as the thecal sac and neural structures 1. This is particularly useful in patients with subacute or chronic lower back pain, with or without radiculopathy, who have failed 6 weeks of conservative therapy and are believed to be candidates for surgery or intervention, or if diagnostic uncertainty remains. Some key points to consider when evaluating lower back pain include:

• MRI has excellent soft-tissue contrast and accurately depicts lumbar pathology, including disc degeneration, as well as the thecal sac and neural structures 1.
• CT myelography of the lumbar spine can be useful in assessing the patency of the spinal canal/thecal sac and of the subarticular recesses and neural foramen, and has safety advantages over MRI for patients who have implanted medical devices that are not MRI safe or conditional 1.
• CT lumbar spine without IV contrast may be useful for preoperative planning, and can also be used to assess facets and neural foramina, and is equal to MRI for predicting significant spinal stenosis and excluding cauda equina impingement 1.
• Radiography alone is not sufficient for guidance on surgical or interventional options without MRI and/or CT imaging, but can be seen as complementary, and upright radiographs provide useful functional information about axial loading 1. However, it's worth noting that the choice of imaging modality may depend on the specific clinical scenario and patient factors, such as the presence of metallic implants or significant artifact from metallic surgical hardware on MRI 1. In general, MRI is the preferred initial imaging modality for evaluating lower back pain, due to its excellent soft-tissue contrast and ability to accurately depict lumbar pathology 1.

From the Research

CT Scan for Lower Back Pain Evaluation

To evaluate lower back pain, a specific type of CT scan is not explicitly mentioned in the provided studies. However, the following points can be considered:

• Computed Tomography (CT) is one of the imaging techniques available for diagnosing lumbar spinal pathology in adult patients with low back pain or sciatica 2.
• The diagnostic performance of CT in identifying lumbar disc herniation has been studied, with pooled summary estimates of sensitivity and specificity reported as 77.4% and 73.7%, respectively 2.
• CT scans can be used in conjunction with other imaging modalities, such as PET/CT, to evaluate facet and disc abnormalities in patients with low back pain 3.
• The choice of imaging modality depends on various factors, including the suspected cause of the lower back pain and the presence of any underlying conditions 4.

Imaging Modalities for Lower Back Pain

The following imaging modalities can be used to evaluate lower back pain:

• Computed Tomography (CT) 2, 4
• Magnetic Resonance Imaging (MRI) 4, 5, 6
• Positron Emission Tomography/Computed Tomography (PET/CT) 3
• Myelography 4

Considerations for Imaging Modalities

When choosing an imaging modality, the following factors should be considered:

• The suspected cause of the lower back pain 4
• The presence of any underlying conditions, such as lumbar spinal stenosis or herniated discs 4, 5, 6
• The need for contrast enhancement or other specialized imaging techniques 3, 5