What are the indications for MRI in the workup of lumbosacral radiculopathy?

Updated: Jan 25, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD  more...
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Answer

The use of MRI should be reserved for selected patients, such as the following:

Immediate MRI of the spine may be indicated in patients with progressive neurologic deficits or cauda equina syndrome, in patients with a presentation that is suggestive of malignancy, in patients with a known history or high risk of malignancy, or in cases in which there is a clinical suspicion to evaluate for a possible inflammatory disease or infection.

MRIs are not necessary in all patients who have examination findings that are consistent with a radiculopathy; in fact, these studies should generally be reserved for those cases in which the imaging results are likely to guide treatment.

Although many clinicians prefer to obtain an MRI prior to planning an epidural steroid injection, recent literature suggests this practice may not provide superior outcomes. [8]

When physical examination and electrodiagnostic findings do not indicate the exact levels of pathology in a patient who is in need of a selective nerve root block, MRI may help the physician to determine the exact level of pathology (see Other Tests, Electrodiagnosis, below).

In the absence of red flags, many patients (even those with a classic lumbosacral radiculopathy) can and should be managed without an MRI, especially if these individuals are not being considered for surgery or injections. Some clinicians reserve MRI for those patients in whom the treatment response is not as expected.

The addition of gadolinium for the MRI study is not necessary in most cases unless the patient has had a previous surgery or there is interest in the enhancing qualities of a previously observed lesion.


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