Imaging

Spinal Stenosis/Spinal Cord Compression

Preliminary Diagnosis: Spinal stenosis / spinal cord compression

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

  • Noncontrasted intradural protocol MR of the (cervical, thoracic, and/or lumbar spine) in patients without a history of prior back surgery.

  • In patients with prior back surgery, the first-line imaging modality for diagnosis is a contrasted intratradural protocol MR of the (cervical, thoracic, and/or lumbar spine.

II. Describe the advantages and disadvantages of this technique for diagnosis of spinal stenosis/spinal cord compression.

Advantages

  • Does not expose patients to ionizing radiation.

  • Contrasted MR imaging is able to differentiate recurrent disc herniation from granulation tissue.

  • Able to well characterize any particular soft tissue abnormalities/processes resulting in spinal stenosis.

Disadvantages

  • Expensive.

  • Time-consuming.

  • Requires significant patient cooperation to minimize motion artifact.

  • Inferior for evaluation of osseous abnormalities compared to other imaging modalities.

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

  • Contraindications include patients with non-MR compatible hardware.

  • Gadolinium contrast is contraindicated in patients with a GFR less than or equal to 30.

IV. What alternative imaging techniques are available?

CT myelography.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of spinal stenosis / spinal cord compression.

Advantages

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

  • May be performed much faster than MR exams.

Disadvantages

  • Exposes the patient to ionizing radiation.

  • Invasive procedure

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

  • May be contraindicated in pregnancy.

  • Relative contraindication to contrast use in patients with renal failure.

  • Relative contraindication to contrast use in patients with contrast allergy.

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