Article

Imaging is an integral part of the clinical examination of the patient with back
pain; it is, however, often used excessively and without consideration of the
underlying literature. The primary role of imaging is the identification of
systemic disease as a cause of the back or limb pain; magnetic resonance imaging
(MRI) excels at this. Systemic disease as a cause of back or limb pain is,
however, rare. Most back and radiating limb pain is of benign nature, owing to
degenerative phenomena. There is no role for imaging in the initial evaluation of
the patient with back pain in the absence of signs or symptoms of systemic
disease. When conservative care fails, imaging may be undertaken with due
consideration of its risks: labeling the patient as suffering from a degenerative
disease, cost, radiation exposure, and provoking unwarranted minimally invasive
or surgical intervention. Imaging can well depict disc degeneration and disc
herniation. Imaging can suggest the presence of discogenic pain, but the lack of
a pathoanatomic gold standard obviates any definitive conclusions. The imaging
natural history of disc herniation is resolution. There is very poor correlation
between imaging findings of disc herniation and the clinical presentation or
course. Psychosocial factors predict functional disability due to disc herniation
better than imaging. Imaging with MRI, computed tomography (CT), or CT
myelography can readily identify central canal, lateral recess, or foraminal
compromise. Only when an imaging finding is concordant with the patient's pain
pattern or neurologic deficit can causation be considered. The zygapophysial
(facet) and sacroiliac joint are thought to be responsible for axial back pain,
although with less frequency than the disc. Imaging findings of the structural
changes of osteoarthritis do not correlate with pain production. Physiologic
imaging, either with single-photon emission CT bone scan, heavily T2-weighted MRI
sequences (short-tau inversion recovery), or gadolinium enhancement, can detect
inflammation and are more predictive of an axial pain generator.
CI - Copyright (c) 2010 Elsevier Inc. All rights reserved.

Langue : ANGLAIS