Working from caudal to rostral observe:

·         Neural foramina and nerve roots: Observe for compression

·         Intervertebral discs:  width, protrusions/ herniations

·         Spinal column:  alignment (spondylolisthesis), vertebral body shape (compression fractures, Schmorls’ nodes), posterior bony elements (spondylolysis), degenerative end plate changes (changes in fat content), hemangiomas.

·         Retroperitoneal space: adenopathy, masses, great vessel aneurysm, etc

STEP (2)   T2 sagittals (spinal fluid is bright)

Working from caudal to rostral observe:

·         Dural sac—cord and rootlets:  width, compression, irregularities

·         Intervertebral discs:  width, protrusions/ herniations, hydration, high intensity zones

·         Spinal column:  alignment (spondylolisthesis), vertebral body shape (compression fractures, Schmorls’ nodes), posterior bony elements (spondylolysis), degenerative end plate changes (changes in fat content), hemangiomas.

·         Posterior bony elements:  breakage, listhesis, pseudo-articulations, etc.

STEP (3) T1 Axials  (CSF appears gray and fat appears bright) Proceed sacral to rostral

Orientation – neural foramina lie at level of discs.

·         Intervertebral discs—  continuity, bulges, etc.

·         Bone – Vertebral bodies; spondylolisthesis, posterior bony elements (spondylolysis,  breakage)

·         Ligamentam flavum:  thickened appearance, impingement

·         Retroperitoneal space: adenopathy, masses, muscle, etc.

STEP (4) T2 Axials   (spinal fluid appears bright)  Work from sacrum to rostral

·         Intervertebral discs—  continuity, bulges, etc.

·         Bone – Vertebral bodies; spondylolisthesis, posterior bony elements (spondylolysis,  breakage)

·         Ligamentam flavum:  thickened appearance, impingement

·         Retroperitoneal space: adenopathy, masses, muscle, etc.

·         Assessment: Ensure you have covered all structures. Assess need for other studies

·         Plan:  Patient care plan.


Rainville, J et al. A Guide to Interpreting Magnetic Resonance Imaging of the Lumbar Spine. Harvard Department of PM&R Lecture Series. Adapted with permission from James Rainville, M.D.

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