Approach to Reading MRI of the Spine

It's another back pain type of day in Minor Care.  3 hours into your shift and you've seen 6 patient's with back pain.  You quickly evaluate them asking them about red flag symptoms, searching for signs of neurologic injury on your physical exam.  As you talk to Jane, your next patient, you get worried she doesn't have simple musculo-ligamentous back pain.  Jane has a history of IVDU and states her last use was 3 months ago.  She cites some subjective fever and chills over the past several days along with aching low back pain which has been getting steadily worse.  On exam, you find she is febrile with a temperature of 101.4, tachycardic to 110, with a normal blood pressure.  She has midline upper lumbar and lower thoracic spinal tenderness to palpation.

You head back to your workstation to put in orders.  You think through the differential which include osteomyelitis, diskitis, and spinal epidural abscess.  You put in some orders for pain medications and contemplate your choice of imaging.  MRI? with contrast? without contrast?  Once you get the images, how do you interpret them?  You're used to CT's but all the different sequences of an MRI throws you for a loop.

Take a look at this 6-min video from Dr. Michael Miller to give yourself a refresher on the approach to reading MRI or the spine.