Investigations
The investigation of lumbar disc prolapse should include:
- lumbar MRI:
- the definitive investigation if the facility is available (1)
- the definitive investigation if the facility is available (1)
- plain X-rays:
- of limited benefit in the investigation of lumbar disc disease (2)
- may reveal loss of a disc space or spondylolisthesis
- it is more important in excluding other causes, e.g. metastatic bony changes
- radiculography:
- may show a filling defect in the theca on an AP or lateral view
- may show obliteration or displacement of the nerve root sleeve
- spinal CT:
- may detect small, laterally-placed protrusions which may be missed on radiculography (1)
- shows hypertrophied facet joints and the diameter of the spinal cord
- electromyography:
- denervation in the muscles supplied by the affected roots may be shown
- a low specificity test
Reference
- Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014 Jan;14(1):180-91.
- Expert Panel on Neurological Imaging, Hutchins TA, Peckham M, et al. ACR Appropriateness Criteria® Low Back Pain: 2021 Update. J Am Coll Radiol. 2021 Nov;18(11s):S361-S379.
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