Order and interpret investigations of common spine disorders, lumbago sciatica, brachial syndrome, brachial neuralgia, cervical and lumbar spondylosis
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lumbar cervical spondylosis investigations imaging
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The guide above covers all five conditions you asked about. Here are the key clinical principles to anchor the investigations:
Imaging must follow the patient, not precede the diagnosis. Plain radiographs show bony changes of spondylosis in the vast majority of older adults regardless of symptoms — their presence is not proof of causation. MRI findings similarly have high false-positive rates, so clinical correlation with history, dermatomal distribution, and examination findings is essential before attributing a patient's pain to any imaging abnormality.
Hierarchy of investigations:
- Plain X-ray → identifies structural deformity, fractures, instability, gross degeneration
- MRI → neural compression, disc pathology, cord signal changes (gold standard for soft tissue)
- CT ± myelography → bony detail, post-surgical anatomy, MRI contraindicated
- EMG/NCS → localise and quantify nerve/root dysfunction, distinguish radiculopathy from plexopathy/peripheral neuropathy
- Vascular studies (Doppler, MRA) → TOS with vascular component
Urgent investigation triggers: Any signs of cord compression (myelopathy — hyperreflexia, Babinski, clonus, Lhermitte's, sphincter dysfunction), progressive motor weakness, cauda equina syndrome (saddle anaesthesia, bladder/bowel dysfunction), or suspected infection/malignancy.
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