What is the role of MRI in the workup of lumbosacral facet syndrome?

Updated: Nov 19, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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Answer

In general, MRI is not indicated for the evaluation of nonradicular LBP.

The main utility of MRI is for excluding pathologies other than Z-joint arthropathy, because many degenerative changes in the Z-joint are asymptomatic. Similarly, true Z-joint–mediated pain may be present despite a normal MRI examination. [18]

MRI provides detailed anatomic images of the soft structures of the spine, such as the intervertebral discs, which often show degenerative changes before Z-joint pathology. [19]

MRI also may illustrate nerve root entrapment secondary to Z-joint hypertrophy or a synovial cyst and may help visualize the intervertebral foramen; however, Z-joint pathology may be present despite normal imaging study findings.

MRI is particularly useful for the evaluation of a synovial cyst emanating from a Z-joint and for distinguishing a synovial cyst from other abnormalities. Gadolinium enhancement is useful in the evaluation of a potential synovial cyst. Also helpful is to make the radiologist aware that a synovial cyst is part of the differential diagnosis because this entity is often overlooked.

Gadolinium-based contrast agents (gadopentetate dimeglumine [Magnevist], gadobenate dimeglumine [MultiHance], gadodiamide [Omniscan], gadoversetamide [OptiMARK], gadoteridol [ProHance]) have recently been linked to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). For more information, see the Medscape Reference topic Nephrogenic Systemic Fibrosis.

NSF/NFD has occurred in patients with moderate to end-stage renal disease after being given a gadolinium-based contrast agent to enhance MRI or MRA scans. As of late December 2006, the FDA had received reports of 90 such cases. Worldwide, over 200 cases have been reported, according to the FDA. NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip bones or ribs; and muscle weakness. For more information, see the FDA Public Health Advisory or Medscape.


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