More articles from Spine

In this secondary analysis of the CT and MR imaging studies of the prospective, double-blind Lumbar Epidural Steroid Injections for Spinal Stenosis (LESS) trial participants, the authors found no differences in baseline imaging characteristics between those receiving epidural corticosteroid and lidocaine and those receiving lidocaine alone injections. No imaging measures of spinal stenosis were associated with a differential response to corticosteroids, indicating that imaging parameters of spinal stenosis did not predict a response to epidural corticosteroids.

Using spinal MR imaging to dichotomize patients with spontaneous intracranial hypotensioninto spinal longitudinal extradural CSF collection positive and negative populations accurately determines the nature of their underlying CSF leak (mechanical dural tear versus CSF venous fistula or nerve root sleeve leak), correctly predicts in whom autologous nondirected and directed epidural blood patch may work and in whom it will fail, and finally prescribes the positioning (prone versus decubitus) for subsequent dynamic myelography providing the most efficient pathway to definitive leak localization and repair. Using this systematic approach, the authors have been able to identify the exact site of CSF leakage in 27 (87%) of 31 consecutive patients referred to their institution with MR imaging evidence of SIH.