1. SUSPECTED SPINAL STENOSIS
MRI Lumbar Spine Request Guidance
GPs have direct access for MR imaging of the lumbar spine for patients with suspected malignancy or spinal stenosis.
If your patient does not fulfil the criteria below, please consider referring to the Community Integrated Back Pain Service
If you suspect your patient has acute cauda equina syndrome please refer to ED
If you suspect your patient has discitis please discuss with acute medical admissions.
SUSPECTED MALIGNANCY
Is there a history of cancer and new onset leg or back pain?
If yes to both - On ICE request - MRI Lumbar / Thoracic / Cervical spine - URGENT
Please also consider requesting the following tests:
CRP yes / no
FBC yes / no
Bone Profile yes / no
LFTs yes / no
Myeloma screen yes / no
SUSPECTED SPINAL STENOSIS
Clinical history suggestive of spinal stenosis
(Back / leg pain on walking which settles with stopping and sitting and recurs after walking a similar distance. Usually patients have little or no leg pain at rest )
Yes / No
HIP Pain/osteoarthritis hip excluded Yes / No
Vascular Claudication excluded Yes / No
Patient would consider surgical intervention. Yes / No
If yes to all - On ICE request - MRI Lumbar - ROUTINE
If no to any of the above questions then consider referral to Community Integrated Back Pain Service.