Investigation of the lumbar spine is begun using simple x-rays that can show spondylolisis/listhesis, osteoporotic fractures, degenerative disease or more rarely, ankylosing spondylitis. It consists in an overall analysis, but given its ease of access, it is useful since it can reveal significant clinical anomalies. The decision to pursue investigation using a CT scan or magnetic resonance imaging depends on many factors, among them accessibility, costs, age of the patient and the duration of symptoms (acute versus chronic).
In the presence of acute lower back pain unresponsive to conservative treatment, both methods can be considered for highlighting a hernia.
In the presence of lower back pain accompanied by significant clinical symptoms, such as sphincter disorders, extensive neurological deficit, neoplastic antecedent, steroid use, trauma and infection rate, magnetic resonance is the preferred exam.
In the presence of chronic back pain without infection rate or neoplasia, the patient most likely suffers from degenerative disease with or without spinal stenosis. Two imaging options are possible based on availability, cost or contraindications: CT scan or MRI. A CT scan is an excellent exam for detailing facet joints, yellow ligaments and their hypertrophic changes, as well as their impact on the caliber of the spinal canal and foramens. Spinal stenosis is often multifactorial, and assessment of its various components is essential in the choice of treatment. MRI provides a complete tiered diskal assessment of bone and intraductal structures, as well as the conus medullaris.
Postoperative assessment of the spine: assessment using magnetic resonance imaging with Gadolinium is the method of choice. It helps differentiate between postoperative modifications, fibrosis, recurrent disk herniation, arachnoiditis or infectious complications, such as spondylitis.