Diagnostic Imaging of the Lumbar Spine

Original Editor - Jigs Coligado

Top Contributors - Melissa Coetsee, Jigs Coligado, Kim Jackson and Lucinda hampton  

Introduction

Diagnostic imaging is an essential component of the Physical Therapy assessment process. Imaging information assists Physical Therapists in screening for critical conditions and in defining musculoskeletal disorders. Diagnostic imaging results can be integrated into the PT plan of care to help detect barriers to functional mobility and to choose safe and appropriate interventions. A general article on diagnostic imaging for Physical Therapist can be accessed in Physiopedia where it identifies MRI, X-ray, CT scans, and bone scans as leading examples of diagnostic imaging that serve as useful tools for diagnosis, prognosis, intervention, and assessment of injuries. Physical Therapists normally request for diagnostic Ultrasound and X-ray for their patients with musculoskeletal disorders. This found in the study of Gross et al., in which X-ray was most common followed by ultrasound imaging.

This page will cover the four diagnostic imaging modalities commonly used in lumbar spine disorders.

Radiograph (X-ray)

Considered as a first-line imaging modality for suspected disorders of musculoskeletal origin.  A general description can be accessed in a Physiopedia page about X-ray. 

X-rays can evaluate lumbar alignment, vertebral body and disk space size, bone space and alignment, and gross evaluation of soft tissue structures. Requests for lumbar spine x-rays continues to be high among physiotherapists before treatment for low back pain. Clinically X-ray modality is capable of detecting lumbar spine dislocation and fracture and monitors fracture healing.

Diagnostic Ultrasound

It is a cross-sectional imaging method based on sound waves reflected off tissue interfaces. Allows imaging of muscle while testing with resistance as well as stress testing of ligaments. Rapid and least invasive examination of tissues close to the skin surface of the lumbar region, including cortical outline of lumbar vertebra, paralumbar muscles and tendons, spinal ligaments, intervertebral disks, and nerves.

Clinically it is capable of detecting tears of the paralumbar muscles, tendons, and ligaments; degenerative changes of tendons paralumbar muscles; neuropathies of lumbar spinal nerves; inflammatory arthritis affecting the lumbar spine; and cysts in the lumbar region.

Magnetic Resonance Imaging (MRI)

MRI discriminates lumbar spine disorders as to traumatic, degenerative, or inflammatory  Tumor of the spinal cord and cauda equine can also be evaluated through MR imaging. An article on the general description of MRI can be accessed on Physiopedia.

Clinical uses include detection of lumbar disk herniation, tear of the tendons and ligaments of the lumbar spine, and lumbar vertebra affectation such as tumors, avascular necrosis, and stress fractures.

Computed Tomography

The modality can evaluate complex trauma and bony abnormalities of the lumbar region. CT scan is generally described in a Physiopedia page. It provides detailed digital cross-sectional images of the body relatively free from the superimposition of the different tissues. Clinically the modality can detect fractures of the lumbar spine, especially complex fractures, arthritic changes of the lumbar vertebra, and lumbar spinal stenosis.