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Low back pain accounts for 17% of all physician visits of people aged 65 and older. [37] From this population, a large portion of radicular pain stems not from disk pathology, but from lumbar spinal stenosis. [37] According to Kalff et al., 21% of people over the age of 60 have lumbar spinal stenosis, as confirmed by radiological screening. [38]
Despite this, the use of imaging in low back pain has increased. [10] Some low back pain is caused by damaged intervertebral discs, and the straight leg raise test is useful to identify this cause. [5] In those with chronic pain, the pain processing system may malfunction, causing large amounts of pain in response to non-serious events. [11]
Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. [2] Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. [1]
Dural ectasia is defined as a ballooning or outpouching of the dura with a dural volume greater than two standard deviations above the mean value in controls. [9] It is usually identified by MRI or CT Scan, [7] which can be used to distinguish it from tumors. [16]
The MRI uses electromagnetic signals to produce images of the spine. MRIs are helpful because they show more structures, including nerves, muscles, and ligaments than seen on X-rays or CT scans . MRIs are helpful in showing exactly what is causing spinal nerve compression.
However, this may be an underestimate due to the high sensitivity of MRI to identify lumbar pathologies (leading to incorrect discogenic diagnoses), the lower referral rate of deep gluteal syndrome patients to neurosurgeons and orthopedic spine specialists (leading to missed diagnoses), and the frequent failure to recognize the diagnosis.
Thus when X-ray findings are normal but SCI is still suspected due to pain or SCI symptoms, CT or MRI scans are used. [89] CT gives greater detail than X-rays, but exposes the patient to more radiation, [91] and it still does not give images of the spinal cord or ligaments; MRI shows body structures in the greatest detail. [10]
Magnetic resonance imaging (MRI) is the preferred modality for the evaluation of back pain and visualization of bone, soft tissue, nerves and ligaments. X-rays are a less costly initial option offered to patients with a low clinical suspicion of infection or malignancy, and they are combined with laboratory studies for interpretation.
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