Lumbar disk herniation: MR imaging assessment of natural history in patients treated without surgery.

The aim of this study was to evaluate the evolution of lumbar disk herniation in patients treated without surgery. Sixty-nine patients with a lumbar disk herniation proved at magnetic resonance (MR) imaging underwent a follow-up MR imaging study. The disk herniations evaluated during both MR imaging examinations were measured and classified into four categories according to the change in size that occurred. The patients were also divided into three clinical classes on the basis of the clinical outcome. Sixty-three percent of the patients showed a reduction of disk herniation of more than 30% (48% had a reduction of more than 70%), while only 8% demonstrated worsening of the clinical picture. These findings suggest that lumbar disk herniation may be primarily a medical (nonsurgical) disease and that MR imaging could play an important role in management of and research into the disorder.     

Recurrent postdiskectomy low back pain: MR-surgical correlation

The preoperative MR findings in 11 patients, all of whom had developed recurrent low back pain after surgery for herniated lumbar intervertebral disk, were correlated with the surgical findings to determine possible criteria for distinguishing recurrent disk herniation from postoperative scar (extradural fibrosis). The preoperative MR findings agreed with the surgical findings in seven of eight patients with recurrent disk herniation and in six of nine individuals with extradural fibrosis. The most important parameters in differentiating recurrent herniated disk from extradural scar were the configuration and margination of the extradural mass rather than its signal characteristics. The most reliable MR sign for recurrent herniated disk was the presence of a sharply marginated focal polypoid disk protrusion beyond the posterior margins of the adjacent vertebral bodies shown to best advantage on sagittal T1- and T2-weighted and axial T1-weighted spin-echo MR images. Disk herniations usually maintained isointensity with the intervertebral disk of origin, while extradural fibrosis exhibited variable signal intensity. The preoperative diagnosis of extradural fibrosis on MR was based primarily on its irregular configuration and extension. This study suggests that preoperative differentiation between scar and recurrent herniated disk is possible with MR when morphology and topography are considered in addition to signal intensity.     

MR imaging of epidural hematoma in the lumbar spine

OBJECTIVE: To bring attention to the MR imaging appearance of epidural hematoma (EDH) in the lumbar spine as a small mass often associated with disk herniation or an acute event. This paper will show our experience with this entity and describe criteria for its MR imaging appearance. DESIGN AND PATIENTS: Thirteen cases of prospectively diagnosed EDH of the lumbar spine were compared with 12 cases of prospectively diagnosed prominent epidural extrusion. Our criteria were retrospectively evaluated by the two authors for their presence or absence in each case. The chi-square test for nominal data was applied. MR imaging criteria utilized to distinguish EDH from disk herniation at our institution include: (1) signal different from disk, (2) high signal on T1-weighted images, either centrally or peripherally, (3) teardrop- or egg-shaped mass, in the sagittal plane, (4) size greater than half the vertebral body height in a craniocaudal dimension, (5) primarily retrosomatic epidural location, (6) plasticity - the mass is seen to conform closely to the contours of bone (e.g., in the lateral recess), (7) little or no disk space narrowing unless associated with disc herniation. RESULTS: Chi-square analysis demonstrated each criterion to significantly differentiate between EDH and extrusion. Only six of 13 EDH cases went to surgery in spite of their relatively large size. Two of six patients were diagnosed as having epidural clot consistent with hematoma at the time of surgery. The four patients who were not diagnosed at surgery revealed only small disk herniations or fragments of disk. CONCLUSIONS: The occurrence of EDH is more frequent than previously suspected. Spontaneous EDH is frequently associated with disk herniation and acute events such as sneezing or coughing. Most cases of spontaneous EDH will resolve prior to surgery with only the minority becoming chronic in order to be seen at surgery as an encapsulated mass. MR imaging can reliably identify EDH and distinguish between EDH and large disk extrusions.     

Spontaneous resolution of lumbar disk herniation: predictive signs for prognostic evaluation

Spontaneous regression of lumbar disk herniation in patients who did not undergo surgery nor interventional therapy is reported in up to 70% of cases; however, no perspective study has clarified the possible predictive signs of a positive evolution. Aim of our study was to search for plan and contrast enhancement MRI signs able to define disk-herniation resolution. We enrolled 64 patients, affected by 72 lumbar disk herniations as per the classification proposed by the American Society of Neuroradiology (Nomenclature and Classification of Lumbar Disk Pathology 2001). MRI examinations were performed by 1.5-T magnet, using T1w SE sequences on sagittal and axial planes, before and after contrast, and T2w FSE ones on the same planes. The following parameters were considered: age, sex, level and size of disk herniation, its relationship to the spinal canal, clinical onset interval, type of disk herniation, herniated-material signal intensity on T2w sequences and its pattern of contrast enhancement. All the patients, conservatively treated, underwent clinical and MRI follow-up examination after 6 months. At MRI follow-up exams spontaneous regression of disk herniation was observed in 34.72% of cases. Among these, free fragments regressed in 100% of cases, herniations with high signal intensity on T2w sequences in 85.18%, herniations with peripheral contrast-enhancement in 83% of cases. Disk-herniation evolution did not show any relationship with location, size and level. Our study demonstrates that MRI, in addition to its high diagnostic value, offers predictive information about disk-herniation evolution.     

Differentiation between postoperative scar and recurrent disk herniation: prospective comparison of MR, CT, and contrast-enhanced CT

Twenty-five symptomatic postlumbar surgery patients had findings on lumbar spinal noncontrast CT that were equivocal for distinguishing recurrent disk herniation from postoperative epidural fibrosis (scar). Contrast-enhanced CT and lumbar MR imaging were performed to differentiate these two conditions. Of the 14 levels, surgically explored, the diagnosis of scar or recurrent disk herniation was correct with contrast-enhanced CT at 10 levels and with MR imaging at 11 levels. At the levels operated on less than 2 years prior to MR imaging, scar more frequently demonstrated intermediate than low signal intensity. Scar older than 2 years most often showed low signal intensity. These preliminary findings suggest that MR may be useful in differentiating postoperative fibrosis from recurrent disk herniation in a significant proportion of patients whose unenhanced CT scans are equivocal.     

Magnetic resonance imaging of the lumbar spine with CT correlation

The results of magnetic resonance (MR) imaging and computed tomography (CT) in 18 patients with known degenerative disk disease of the lumbar spine were compared. In 60 intervertebral disk levels studied, there were 17 disks with degeneration and disk bulge, and 15 herniated disks. Final diagnoses were based on several factors, with surgical confirmation in five patients. There was good correlation between the two methods at 51 of the 60 levels studied. However, there were major discrepancies in interpretation at nine intervertebral disk levels. These included three false-positive MR imaging interpretations of a herniated disk and one false-negative herniated disk on MR imaging. MR imaging detected one case of disk herniation that was missed prospectively on CT. There were also four presumed degenerated disks seen on MR scans that appeared normal on CT. The conus medullaris was imaged in 16 of 18 patients. The sagittal view proved best for demonstrating both disk abnormality and the conus medullaris. The transaxial view was sometimes helpful in localizing a disk herniation, but partial-volume averaging in the 7-mm slice thickness limited its usefulness. There were five disk herniations that could not be accurately localized on the MR scan. MR imaging proved more sensitive than CT in detecting early disk disease, which appeared as decreased signal intensity within the disk. In three postoperative cases, MR imaging was better able to distinguish between recurrent disk herniation and postoperative scar formation. CT, on the other hand, was more specific in distinguishing herniated disk from disk bulge and proved far superior to MR imaging in localizing disk herniation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sequestered disc herniation mimicking psoas abscess: A rare case report

Intervertebral disc herniation is common condition, with majority occurring in lumbar and cervical spine. Most lumbar disk herniations occur within the spinal canal, with approximately 7%-10% identified within the foramen or extraforaminal location. Extraforaminal disc herniation in extreme lateral, retroperitoneal or anterior terms are used when disc material is seen towards anterolateral or anterior to the spine. Disc herniation in these locations is easily mistaken for an abscess or a neoplasm especially when it is not connected to the parent disc (sequestered disc). We describe a case of 60-year male who initially was misdiagnosed as psoas abscess and subjected to invasive investigation which later turned out to be histologically confirmed disc sequestration in the retroperitoneum. Thus, knowledge of this condition is essential in avoiding unnecessary workup and treatment.     

Lumbar disk herniation and canal stenosis: value of intraoperative sonography in diagnosis and surgical management

One hundred four patients with preoperative diagnoses of lumbar canal stenosis, disk herniation, or a combination of both were evaluated with intraoperative sonography with the intent of (1) describing the sonographic characteristics of herniated disks and distinguishing these from bulging anuli, epidural fat, scar tissue, and spondylolisthesis; (2) establishing criteria for adequate decompression of canal stenosis; and (3) determining the usefulness of sonography in monitoring disk removal. Disk material demonstrates medium echogenicity, different in its sonographic features from bone, epidural fat, scar tissue, and epidural veins. A sonographic diagnosis of disk herniation was made in 43 cases, 41 of which were confirmed during surgery. Sonography established the presence or absence of disk herniation (confirmed by surgery) in 14 of 19 patients who had equivocal preoperative findings. After routine diskectomy, residual disk material was found in 17 (41%) of 41 patients, which led to further surgery in 16 patients with removal of the additional disk fragments. In 84 patients undergoing decompressive surgery for canal stenosis, sonography detected residual canal compression in 19 (23%), which led to a widened decompression in 15 of these patients. Sonography can differentiate disk material from other normal or abnormal structures in the canal; therefore, sonographic monitoring helps to ensure adequate bony decompression and complete diskectomy. We conclude that intraoperative sonography is an important tool in the surgical management of lumbar disk disease and stenosis.     

MR imaging of foraminal and extraforaminal lumbar disk herniations

Foraminal and extraforaminal disk herniations are less frequent than intraspinal herniations at the lumbar level and more difficult to diagnose. They are undetected by myelography and distinction between them and an enlarged nerve root may be difficult with CT. Thirty-three patients presenting with persistent radiculopathy and showing an image suggesting a far lateral disk herniation on CT at 34 disk levels were prospectively imaged with magnetic resonance (MR). In all cases the disk fragment was identified and its separation from the nerve root was possible. This separation was more readily visible on sagittal or angled coronal views. The exact location of the herniation in relation to the facet joints and the pedicles was best assessed with MR: Ten were purely intraforaminal, 8 extraforaminal, and 15 both. Cephalad migration was noted on the sagittal lateral facet plane in 71% of cases. Surgical correlations were available for 25 disks. Three were falsely positive for disk herniation. Enlarged foraminal veins were responsible for this appearance as confirmed by surgery in two of these. When a prediction of disruption of the lateral extension of the posterior longitudinal ligament was made, it was confirmed at surgery in 52% of cases because of extreme lateralization of the herniations.     

The injured spinal cord. Evaluation with magnetic resonance and intraoperative sonography

MR is now the study of choice in evaluating both the acutely and previously injured spinal cord. A number of crucial diagnoses can be made with MR that are difficult to obtain otherwise. The discovery of acute disk herniation in association with a fracture/dislocation may indicate the need to remove the disk and stabilize the patient on a relatively urgent basis, and the approach to the stabilization procedure (either anterior or posterior) can be determined by the MR findings. Hemorrhage outside the cord may require immediate surgical attention, and identification of abnormal signals from the cord itself consistent with hemorrhage or edema may help to explain the patient's clinical status. Our experience indicates that obtaining an MR in acutely injured patients who have incomplete injuries is particularly helpful in their surgical management. The presence of intramedullary or extramedullary cysts in the previously injured spine can explain a worsening clinical picture and direct the surgeon to the proper area (or areas) for decompression. Flow-sensitive studies currently under evaluation are giving a greater insight into the dynamics of these cysts. Late decompression of cord tissue and roots requires accurate preoperative MR evaluation of possible bone or disk impingement on neural tissue. In surgery of both the acute and chronically injured spine, intraoperative sonography plays a crucial role. The adequate shunting of intramedullary and subarachnoid cysts, the confirmation of the efficaciously placed Harrington rods, the demonstration of removal of compressive bone or disk fragments, and the uncovering of important but unanticipated abnormalities such as subligamentous hematoma or an incidentally herniated disk all attest to sonography's value in the operating room. MR preoperatively and sonography intraoperatively are important tools utilized in the care of spine-injured patients.     

Lumbar disk herniation and canal stenosis: value of intraoperative sonography in diagnosis and surgical management

One-hundred-four patients with preoperative diagnoses of lumbar canal stenosis, disk herniation, or a combination of both were evaluated with intraoperative sonography with the intent of (1) describing the sonographic characteristics of herniated disks and distinguishing these from bulging anuli, epidural fat, scar tissue, and spondylolisthesis; (2) establishing criteria for adequate decompression of canal stenosis; and (3) determining the usefulness of sonography in monitoring disk removal. Disk material demonstrates medium echogenicity, different in its sonographic features from bone, epidural fat, scar tissue, and epidural veins. A sonographic diagnosis of disk herniation was made in 43 cases, 41 of which were confirmed during surgery. Sonography established the presence or absence of disk herniation (confirmed by surgery) in 14 of 19 patients who had equivocal preoperative findings. After routine diskectomy, residual disk material was found in 17 (41%) of 41 patients, which led to further surgery in 16 patients with removal of the additional disk fragments. In 84 patients undergoing decompressive surgery for canal stenosis, sonography detected residual canal compression in 19 (23%), which led to a widened decompression in 15 of these patients. Sonography can differentiate disk material from other normal or abnormal structures in the canal; therefore, sonographic monitoring helps to ensure adequate bony decompression and complete diskectomy. We conclude that intraoperative sonography is an important tool in the surgical management of lumbar disk disease and stenosis.     

Lumbosacral nerve root enhancement with disk herniation on contrast-enhanced MR.

PURPOSETo evaluate the clinical importance of nerve root enhancement associated with lumbar disk herniation.METHODSThirty-two patients with lumbar disk herniation were examined with unenhanced and contrast-enhanced MR imaging. We investigated the relationship between nerve root enhancement and location of herniated disk in the epidural space, onset pattern of symptoms, subsequent treatment, and surgical findings.RESULTSTen of the 32 patients had nerve root enhancement, and all belonged to the group with abrupt and severe nerve root compression with no residual space for the root between the herniated disk and the pedicle in the lateral recess. Tight compression of the root without mobility was seen in the four patients with nerve root enhancement who were treated surgically.CONCLUSIONNerve root enhancement may indicate the existence of abrupt and severe compression of the nerve root as well as the presence of severe adhesion of the herniated disk and the nerve root. This finding does not necessarily determine the type of subsequent treatment.     

CT five years after myelographic diagnosis of lumbar disk herniation

Fifty-seven patients were examined with CT 5 years after primary myelography for disabling sciatica and suspected herniated lumbar disk. Forty were in an operated group, 22 with good and 18 with poor results evaluated by occupational handicap (21) 5 years after surgery. Seventeen patients had myelography indicating disk herniation, but were treated conservatively, 9 with good and 8 with poor result. Various spinal dimensions measured at CT did not correlate with outcome. Operated patients had narrower canals than others, and male canals were broader than those in females. Increased amount of scar tissue at L4 level correlated with poor result (p = 0.008). Operated patients with poor result had more advanced lateral stenosis than those treated conservatively (p less than 0.001). Patients with good result after operation had more degeneration observed on CT of erector spinae muscle than those treated conservatively with good outcome. Only 9% of operated patients did not have muscle degeneration. A tendency for more frequent recurrent disk herniations could be seen for conservatively treated patients. The narrowing of the spinal canal 5 years after operation did not correlate with the 5-year outcome.     

Lumbar spondylolysis without spondylolisthesis: recognition of isolated posterior element subluxation on sagittal MR.

PURPOSETo document the occurrence of isolated dorsal subluxation of posterior elements in cases of lumbar spondylolysis without spondylolisthesis both quantitatively (using spinal canal measurements) and qualitatively (by visual inspection) on sagittal MR images.METHODSRetrospective analysis identified 63 patients with lumbar spondylolysis (confirmed by CT or conventional radiography) who had undergone MR imaging. From these we identified 12 patients with pars interarticularis defects but no evidence of spondylolisthesis. Measurements of anteroposterior spinal canal diameters were performed in these 12 patients to ascertain whether the sagittal canal diameter at the level of the spondylolysis exceeded the normal range as determined from 100 control subjects.RESULTSIn 9 of 12 patients the spinal canal was abnormally widened at the level of the spondylolysis because of dorsal subluxation of posterior elements. In 5 of these patients, the subluxation was readily visible on midline sagittal MR images. In 4 patients, spinal canal measurements were necessary to document this phenomenon.CONCLUSIONIn the majority of patients with spondylolysis but without spondylolisthesis, sagittal MR images can show isolated dorsal subluxation of posterior spinal elements.     

The postoperative lumbar spine: enhanced MR evaluation of the intervertebral disk.

PURPOSETo document the pattern of enhancement and morphologic changes on MR images that occur in the intervertebral disk and adjacent vertebral bodies after diskectomy and to correlate the presence of intervertebral disk enhancement with the preoperative and postoperative clinical findings.METHODSPreoperatively, and at 3 months and 6 months after surgery, 94 adults who had first-time surgery for a herniated lumbar intervertebral disk that was associated with radiculopathy, expressed as leg symptoms or signs (with or without lower back pain), were asked to respond to a questionnaire regarding pain, were given serial physical examinations, and were examined with contrast-enhanced MR imaging. The measures of clinical outcome that were evaluated included the straight leg raise sign, radicular pain, and lower back pain. Type of disk herniation, intervertebral disk enhancement, disk space height, and degenerative end-plate changes were also assessed.RESULTSOf the 94 patients evaluated, 19 (20%) had postoperative intervertebral disk enhancement that was not present on the preoperative study. The pattern of enhancement was remarkably consistent, with 18 of the cases showing linear enhancement within the intervertebral disk, manifested as two thin bands paralleling the end plates. End-plate enhancement was present in 7 (37%) of the 19 patients with disk enhancement. There were no significant associations between disk enhancement and specific clinical symptoms before or after surgery.CONCLUSIONOur group of asymptomatic postoperative patients had anular enhancement (curette site), disk enhancement, and vertebral end-plate enhancement on MR images without evidence of disk space infection. This finding points out the need to understand asymptomatic postoperative changes that are sequelae of surgery and not necessarily indicators of infection.     

Observer variation in MRI evaluation of patients suspected of lumbar disk herniation

OBJECTIVE: Our objective was to assess observer variation in MRI evaluation in patients suspected of lumbar disk herniation. SUBJECTS AND METHODS: Two experienced neuroradiologists independently evaluated 59 consecutive patients with lumbosacral radicular pain. Per patient, three levels (L3-L4 through L5-S1) and the accompanying roots were evaluated on both sides. For each segment, the presence of a bulging disk or a herniation and compression of the root was reported. Images were interpreted twice: once before and once after disclosure of clinical information. Interobserver agreement was expressed as unweighted kappa values. RESULTS: Without clinical information, interobserver agreement for the presence of herniation or bulging disk was moderate (full agreement, 84%; kappa = 0.63; 95% confidence interval [CI], 0.53-0.72). Of a total of 352 segments evaluated, there was disagreement on 58 segments (17%): bulging disk versus no defect in 26 (7.4%), bulging disk versus herniation in five (1.4%), and hernia versus no defect in 27 (7.7%). With clinical information, twice as many bulging disks were reported but no new herniations were detected. Agreement slightly decreased, but not significantly (full agreement, 77%; kappa = 0.59; 95% CI, 0.49-0.69; p = 0.12). CONCLUSION: On average, more than 50% of interobserver variation in MRI evaluation of patients with lumbosacral radicular pain is caused by disagreement on bulging disks. Knowledge of clinical information does not influence the detection of herniations but lowers the threshold for reporting bulging disks.     

Cervical spine disk herniation: comparison of CT and 3DFT gradient echo MR scans.

The purpose of this study was to compare CT and MR for the detection of cervical disk herniations. Nineteen patients suspected of harboring degenerative disk disease of the cervical spine underwent thin contiguous section CT myelography (CTM) and thin contiguous section three-dimensional Fourier transform (3DFT) gradient echo MR at 67 disk levels. Blinded readings of a high intensity CSF MR technique for the presence or absence of disk herniation were performed by three neuroradiologists. The intraobserver CT-MR concordances ranged from 84 to 89%. Using CTM as the paragon test, MR demonstrated a sensitivity of 79-91% and a specificity of 82-88% for disk herniation. Mean MR-CT concordance (86%) was nearly equivalent to that of CT-CT intraobserver concordance (88%). When consensus readings were considered, the MR-CT concordance (91%) was slightly higher than that of CT-CT intraobserver concordance (88%). We conclude that thin section 3DFT gradient echo MR with high intensity CSF is a reliable method to screen for degenerative disk disease in the cervical spine, since the agreement between MR and CTM is comparable with the intraobserver agreement of CTM.     

Are paraspinal muscle quantity,lumbar indentation value,and subcutaneous fat thickness related to disc degeneration? An MRI-based study

IntroductionThe aim of the study was to investigate the relationship between lumbar disc herniation and Goutallier classification (GC), lumbar indentation value, and subcutaneous adipose tissue thickness.Methods102 consecutive patients (59 female and 43 male) with lumbar back pain, numbness, tingling, or pain in the lower extremity indicating radiculopathy who had undergone lumbar magnetic resonance imaging (MRI) and had an intervertebral disc herniation in the L4-5 level, were included in the study. 102 patients who have undergone lumbar MRI in the same time period and have no disc herniation were chosen to be the control group and were selected so as to match the herniated group for sex and age. All these patients’ scans were re-interpreted regarding paraspinal muscle atrophy (using the GC), lumbar indentation value, and subcutaneous adipose tissue thickness in the L4-5 level.ResultsThe Goutallier score was higher in the herniated group, compared with the non-herniated group (p < 0.001). There was no statistical difference between herniated and non-herniated groups regarding lumbar indentation value (LIV) and subcutaneous adipose tissue thickness (SATT). A Goutallier score of 1.5 provided the highest sensitivity x specificity value to indicate the disc herniation according to the statistical results. The individuals with a Goutallier score of 2, 3, and 4 have 2.87 times more likely to have disc herniation in their MRIs than the ones with a score of 0 and 1.ConclusionParaspinal muscle atrophy seems to be related to the presence of disc herniations. The cut-off value of GC to indicate the disc herniation in this study might be useful to predict the risk for disc herniation regarding the Goutallier score. The LIV and SATT measured in magnetic resonance images were randomly distributed between individuals with herniated and non-herniated groups, and statistically, no relationship was observed between these groups regarding these parameters.Implications for practiceThe effect of the parameters studied in this research on disc herniations are expected to be an added value to the literature. The awareness of risk factors for intervertebral disc herniations might be used in preventive medicine to predict the risk and understand the tendency of an individual for disc herniations to occur in the future. Further investigations are needed to establish whether there is a causal relationship or correlation between these parameters and disc herniation.     

Can MRI signal characteristics of lumbar disk herniations predict disk regression?

PURPOSE: To assess whether or not MRI signal characteristics of lumbar disk herniations can predict subsequent disk regression. MATERIALS AND METHODS: Medical and radiology records from 1999-2003 were reviewed, and 123 patients who had more than one lumbar MRI during the study interval were identified. Of these, 42 patients had a disk herniation (protrusion, extrusion, or free fragment) identified on their first examination. Six of the 42 patients were not included because of prior lumbar surgery, or inadequate examinations. The remaining 36 patients had a total of 77 examinations to evaluate 44 disk herniations. The herniated disks were evaluated by two CAQ neuroradiologists for size, morphology and a qualitative assessment of the T2 signal. RESULTS: Between the first and last examination, 25 of 44 (57%) herniated disks decreased, 17 (39%) were unchanged, and two increased in size. 9 of 11 (82%) of disk extrusions improved. The mean size of the disks that regressed was significantly larger than those that were unchanged (8.6 mm vs. 6 mm, p=.001). On average, the disks decreased 3.2 mm (37%). Of the disks that decreased in size, 15 (63%) had an area of increased signal on T2-weighted images (T2WI) compared to the parent disk on the initial study. Of the disks that were unchanged, 6 (35%) had increased signal on the T2WI's. CONCLUSION: 57% of herniated disks in this study group decreased in size over time. Larger herniations and extrusions were more likely to regress than smaller herniations. Disks that regressed were more likely to have high signal on T2WI's than those that were stable.     

Coronal MR imaging of the normal 3rd, 4th, and 5th lumbar and 1st sacral nerve roots

Seven healthy volunteers underwent coronal MR imaging at 1.5 tesla of the normal 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots. Coronal slices, 3-mm-thick with a 0.3-mm gap between the slices were obtained (TR/TE 600/22) through the lumbar spinal canal. All the nerve roots were visible on at least one image. One can routinely expect to demonstrate the 3rd, 4th, and 5th lumbar, and 1st sacral nerve roots on T1-weighted, 3-mm-thick coronal MR scans. We found no correlation between the degree of lumbar lordosis and the lengths of the visible nerve roots. Five patients with one of the following spinal problems: anomaly, tumor, disk herniation, and failed back surgery syndrome were examined according to our protocol. In all these cases coronal MR imaging gave the correct diagnosis.