Imaging

Sciatica

Preliminary Diagnosis: Sciatica

I. What imaging technique is first-line for this diagnosis?

  • Noncontrasted extradural protocol MR of the lumbar spine in patients without a history of prior back surgery.

  • In patients with prior back surgery, the first line for diagnosis is a contrasted extradural protocol MR of the lumbar spine.

II. Describe the advantages and disadvantages of this technique for diagnosing sciatica.

Advantages

  • Does not expose the patient to ionizing radiation.

  • Can differentiate recurrent disc from granulation tissue.

  • Can visualize the spinal cord, exiting nerve roots, meningeal layers, and surrounding soft tissues.

Disadvantages

  • Expensive.

  • Time consuming.

  • Requires significant patient cooperation to minimize motion artifact.

III. What are the contraindications for the first-line imaging technique?

Patients with non MR compatible hardware.

IV. What alternative imaging techniques are available?

CT myelography

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing sciatica.

Advantages

  • May be performed in patients with non MR compatible hardware.

  • Faster than MR exams.

Disadvantages

  • Exposes the patient to ionizing radiation.

  • Invasive procedure.

VI. What are the contraindications for the alternative imaging techniques?

  • Relative contraindication in pregnancy.

  • Relative contraindication in patients with renal failure.

  • Relative contraindication with contrast allergy.

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