Investigations

The investigation of lumbar disc prolapse should include:

• lumbar MRI:
  • the definitive investigation if the facility is available (1)
    
    
• plain X-rays:
  • of limited benefit in the investigation of lumbar disc disease (2)
  • may reveal loss of a disc space or spondylolisthesis
  • it is more important in excluding other causes, e.g. metastatic bony changes
    
    
• radiculography:
  • may show a filling defect in the theca on an AP or lateral view
  • may show obliteration or displacement of the nerve root sleeve
    
    
• spinal CT:
  • may detect small, laterally-placed protrusions which may be missed on radiculography (1)
  • shows hypertrophied facet joints and the diameter of the spinal cord
    
    
• electromyography:
  • denervation in the muscles supplied by the affected roots may be shown
  • a low specificity test

Reference

1. Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014 Jan;14(1):180-91.
2. Expert Panel on Neurological Imaging, Hutchins TA, Peckham M, et al. ACR Appropriateness Criteria® Low Back Pain: 2021 Update. J Am Coll Radiol. 2021 Nov;18(11s):S361-S379.