Lumbar Spinal Imaging in Radicular Pain and Related Conditions : Understanding Diagnostic Images in a Clinical Context

There is general agreement that lumbosacral nerve root compression is a prime factor in the pathogenesis of sciatica and neurogenic claudication, although humoral and vascular factors certainly play a role as well. This book focuses on imaging of the various ways in which nerve root compression can come about, and assessing which anatomic features are reliably associated with the occurrence of radicular pain, as opposed to morphologic findings which are probably coincidental. After a discussion of the nature of radicular pain and related symptoms, spinal imaging techniques and options are reviewed, with emphasis on the role of MR myelography in assessing the condition of the intradural nerve roots. A chapter on normal topographic, sectional, and functional (dynamic) radiologic anatomy is followed by a presentation on pathologic anatomy, addressing the various mechanisms of nerve root compression. In the chapter on pre- and postoperative imaging, features which may help to predict the evolution of the symptoms are discussed, with an eye to selecting candidates for surgical treatment. This is followed by a discussion of the role and limitations of imaging studies in various adverse postoperative conditions. In illustrations involving patient studies, imaging features are linked where possible to the clinical symptoms and history of the individuals involved. A general consensus exists,that lumbosacral nerve root compression is the primary cause of sciatica and neurogenic claudication, although humoral and vascular factors certainly play a role as well. This book focuses on imaging the various ways in which nerve root compression can come about, and determining which anatomic features are reliably associated with the production of radicular pain. After a discussion of the nature of radicular pain and related symptoms, spinal imaging techniques and options are reviewed, with emphasis on the role of MR myelography in assessing the intradural nerve roots. A chapter on normal topographic, sectional, and functional radiologic anatomy is followed by presentations on pathologic anatomy, addressing mechanisms of nerve root compression, and on pre- and postoperative imaging. Features relevant to prediction of the natural history are discussed, and a section is devoted to the performance and reporting of a spinal imaging study. Front Matter....Pages i-x The Nature of Radicular Pain and Related Conditions....Pages 1-7 Imaging Techniques for the Lumbar Spine: Conventional Radiology, Computed Tomography; Magnetic Resonance Imaging....Pages 9-30 Normal Anatomy....Pages 31-57 Pathologic Anatomy and Mechanisms of Nerve Root Compression....Pages 59-113 Spinal Imaging in Relation to Surgical Therapy: Pre- and Post-Operative....Pages 115-157 Back Matter....Pages 159-161