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Copyright (c) 2025 Sattam Mansour Abulkhair, Marzog Awwad Alotaibi, Ahmad Ali Almahmadi, Ghanem Ghazi Menwer Alshammari, Abdullah Ahmed Ali Faqihi, Anwar Rifadah Abdullah Alanazi, Anas Mohammed Mohammed Hakami, Hussam Ahmed Hassan Rayyani, Ali Ahmed Samhan Alsuhaymi, Abdulaziz Abdullah Masad Almutiri, Hassan Salman A Almutairi, Omar Mohammed Muflih Alrashdi, Khalid Yousef Ali Alzahrani
This work is licensed under a Creative Commons Attribution 4.0 International License.
Advanced Diagnostic Imaging of the Lumbar Spine for Radiological Assessment-An Updated Review
Corresponding Author(s) : Sattam Mansour Abulkhair
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Low back pain is a major global health problem and one of the most frequent causes of medical consultation and imaging referral. Its etiology ranges from benign degenerative changes to serious conditions such as infection, trauma, malignancy, and postoperative complications. Selecting the appropriate imaging modality is essential for accurate diagnosis, optimized patient management, and avoidance of unnecessary radiation exposure.
Aim: This review aims to provide an updated, comprehensive overview of imaging modalities used in the diagnostic assessment of the lumbar spine, highlighting indications, strengths, limitations, and clinical applications in common and complex lumbar spine pathologies.
Methods: A narrative review approach was used to synthesize current evidence and established guidelines, particularly the American College of Radiology (ACR) appropriateness criteria. Imaging modalities discussed include plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography, nuclear medicine techniques, and angiography, with correlation to anatomical, degenerative, infectious, neoplastic, traumatic, and postoperative conditions.
Results: Plain radiographs remain a first-line tool for assessing gross structural abnormalities, while CT provides superior evaluation of osseous detail and traumatic injuries. MRI offers unparalleled soft tissue contrast and is the modality of choice for disc disease, spinal canal masses, infection, malignancy, and postoperative complications. Nuclear medicine and angiographic studies serve complementary roles in functional assessment and vascular pathology, respectively.
Conclusion: An evidence-based, patient-centered imaging approach tailored to clinical presentation and suspected pathology is critical in lumbar spine evaluation. Integration of multimodal imaging enhances diagnostic accuracy and improves clinical outcomes.
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- Chou R, Deyo RA, Jarvik JG. Appropriate use of lumbar imaging for evaluation of low back pain. Radiologic clinics of North America. 2012 Jul:50(4):569-85. doi: 10.1016/j.rcl.2012.04.005.
- Edwards J, Hayden J, Asbridge M, Gregoire B, Magee K. Prevalence of low back pain in emergency settings: a systematic review and meta-analysis. BMC musculoskeletal disorders. 2017 Apr 4:18(1):143. doi: 10.1186/s12891-017-1511-7.
- Farshad-Amacker NA, Farshad M, Winklehner A, Andreisek G. MR imaging of degenerative disc disease. European journal of radiology. 2015 Sep:84(9):1768-76. doi: 10.1016/j.ejrad.2015.04.002.
- Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB, Holly L, Hunt CH, Jagadeesan BD, Kennedy TA, O'Toole JE, Perlmutter JS, Policeni B, Rosenow JM, Schroeder JW, Whitehead MT, Cornelius RS, Corey AS. ACR Appropriateness Criteria Low Back Pain. Journal of the American College of Radiology : JACR. 2016 Sep:13(9):1069-78. doi: 10.1016/j.jacr.2016.06.008.
- Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. The spine journal : official journal of the North American Spine Society. 2014 Nov 1:14(11):2525-45. doi: 10.1016/j.spinee.2014.04.022.
- Daffner RH, Hackney DB. ACR Appropriateness Criteria on suspected spine trauma. Journal of the American College of Radiology : JACR. 2007 Nov:4(11):762-75
- Pomerantz SR. Myelography: modern technique and indications. Handbook of clinical neurology. 2016:135():193-208. doi: 10.1016/B978-0-444-53485-9.00010-6.
- Malhotra A, Kalra VB, Wu X, Grant R, Bronen RA, Abbed KM. Imaging of lumbar spinal surgery complications. Insights into imaging. 2015 Dec:6(6):579-90. doi: 10.1007/s13244-015-0435-8.
- Pizones J, Izquierdo E, Alvarez P, Sánchez-Mariscal F, Zúñiga L, Chimeno P, Benza E, Castillo E. Impact of magnetic resonance imaging on decision making for thoracolumbar traumatic fracture diagnosis and treatment. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2011 Aug:20 Suppl 3(Suppl 3):390-6. doi: 10.1007/s00586-011-1913-4.
- Kumar Y, Hayashi D. Role of magnetic resonance imaging in acute spinal trauma: a pictorial review. BMC musculoskeletal disorders. 2016 Jul 22:17():310. doi: 10.1186/s12891-016-1169-6.
- Willson MC, Ross JS. Postoperative spine complications. Neuroimaging clinics of North America. 2014 May:24(2):305-26. doi: 10.1016/j.nic.2014.01.002.
- Iagaru A, Young P, Mittra E, Dick DW, Herfkens R, Gambhir SS. Pilot prospective evaluation of 99mTc-MDP scintigraphy, 18F NaF PET/CT, 18F FDG PET/CT and whole-body MRI for detection of skeletal metastases. Clinical nuclear medicine. 2013 Jul:38(7):e290-6. doi: 10.1097/RLU.0b013e3182815f64.
- Dudli S, Fields AJ, Samartzis D, Karppinen J, Lotz JC. Pathobiology of Modic changes. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2016 Nov:25(11):3723-3734
- Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988 Jan:166(1 Pt 1):193-9
- Patten RM, Gunberg SR, Brandenburger DK. Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal CT in patients with trauma. Radiology. 2000 Jun:215(3):831-4
- Herrera Herrera I, Moreno de la Presa R, González Gutiérrez R, Bárcena Ruiz E, García Benassi JM. Evaluation of the postoperative lumbar spine. Radiologia. 2013 Jan-Feb:55(1):12-23. doi: 10.1016/j.rx.2011.12.004.
References
Chou R, Deyo RA, Jarvik JG. Appropriate use of lumbar imaging for evaluation of low back pain. Radiologic clinics of North America. 2012 Jul:50(4):569-85. doi: 10.1016/j.rcl.2012.04.005.
Edwards J, Hayden J, Asbridge M, Gregoire B, Magee K. Prevalence of low back pain in emergency settings: a systematic review and meta-analysis. BMC musculoskeletal disorders. 2017 Apr 4:18(1):143. doi: 10.1186/s12891-017-1511-7.
Farshad-Amacker NA, Farshad M, Winklehner A, Andreisek G. MR imaging of degenerative disc disease. European journal of radiology. 2015 Sep:84(9):1768-76. doi: 10.1016/j.ejrad.2015.04.002.
Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB, Holly L, Hunt CH, Jagadeesan BD, Kennedy TA, O'Toole JE, Perlmutter JS, Policeni B, Rosenow JM, Schroeder JW, Whitehead MT, Cornelius RS, Corey AS. ACR Appropriateness Criteria Low Back Pain. Journal of the American College of Radiology : JACR. 2016 Sep:13(9):1069-78. doi: 10.1016/j.jacr.2016.06.008.
Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. The spine journal : official journal of the North American Spine Society. 2014 Nov 1:14(11):2525-45. doi: 10.1016/j.spinee.2014.04.022.
Daffner RH, Hackney DB. ACR Appropriateness Criteria on suspected spine trauma. Journal of the American College of Radiology : JACR. 2007 Nov:4(11):762-75
Pomerantz SR. Myelography: modern technique and indications. Handbook of clinical neurology. 2016:135():193-208. doi: 10.1016/B978-0-444-53485-9.00010-6.
Malhotra A, Kalra VB, Wu X, Grant R, Bronen RA, Abbed KM. Imaging of lumbar spinal surgery complications. Insights into imaging. 2015 Dec:6(6):579-90. doi: 10.1007/s13244-015-0435-8.
Pizones J, Izquierdo E, Alvarez P, Sánchez-Mariscal F, Zúñiga L, Chimeno P, Benza E, Castillo E. Impact of magnetic resonance imaging on decision making for thoracolumbar traumatic fracture diagnosis and treatment. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2011 Aug:20 Suppl 3(Suppl 3):390-6. doi: 10.1007/s00586-011-1913-4.
Kumar Y, Hayashi D. Role of magnetic resonance imaging in acute spinal trauma: a pictorial review. BMC musculoskeletal disorders. 2016 Jul 22:17():310. doi: 10.1186/s12891-016-1169-6.
Willson MC, Ross JS. Postoperative spine complications. Neuroimaging clinics of North America. 2014 May:24(2):305-26. doi: 10.1016/j.nic.2014.01.002.
Iagaru A, Young P, Mittra E, Dick DW, Herfkens R, Gambhir SS. Pilot prospective evaluation of 99mTc-MDP scintigraphy, 18F NaF PET/CT, 18F FDG PET/CT and whole-body MRI for detection of skeletal metastases. Clinical nuclear medicine. 2013 Jul:38(7):e290-6. doi: 10.1097/RLU.0b013e3182815f64.
Dudli S, Fields AJ, Samartzis D, Karppinen J, Lotz JC. Pathobiology of Modic changes. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2016 Nov:25(11):3723-3734
Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988 Jan:166(1 Pt 1):193-9
Patten RM, Gunberg SR, Brandenburger DK. Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal CT in patients with trauma. Radiology. 2000 Jun:215(3):831-4
Herrera Herrera I, Moreno de la Presa R, González Gutiérrez R, Bárcena Ruiz E, García Benassi JM. Evaluation of the postoperative lumbar spine. Radiologia. 2013 Jan-Feb:55(1):12-23. doi: 10.1016/j.rx.2011.12.004.