Disclosures: Jayesh Vallabh, MD, MBA, FAAPMR: Nothing to disclose

Case Description: Acutely, the patient received a lumbar MRI w/o contrast, showing minimal disc bulge at L4-5 lateralizing to the left with mild neuroforaminal narrowing bilaterally. Given these findings, she was sent to orthopedics to evaluate for gluteal pathology. Left femur MRI was negative for tear or significant pathology to explain her symptoms; she was then referred to our spine center. On presentation, her exam showed tenderness in the left gluteal muscle and pain limited strength assessment of the left lower limb with KF, KE, ADF, APF, EHL and an asymmetrically absent left patellar reflex. Electrodiagnostic testing and MR neurography was ordered for further assessment. EMG showed evidence for an acute L4/5 radiculopathy however paraspinal evaluation was normal. MR neurography showed signal abnormality in the left L4 nerve root likely reflecting compressive neuritis from her left foraminal disc bulge. Patient subsequently underwent a left L4 transformational epidural steroid (ESI)injection and continued physical therapy.

Setting: Outpatient Spine and Pain Management Clinic

Patient: 45-year-old female with history of left sided gluteal pain and radicular pain in the L4/5 distribution for 1 month; onset after lifting a log.

Assessment/Results: The patient received short term benefit after ESI and is planned for repeat ESI to provide additional benefit; long term results with conservative care are pending.

Discussion: This case shows the practical utility of MR neurography in patients with relatively normal standard MRIs but clear radicular symptoms and EMG abnormalities. Establishing a clear diagnosis in this case not only helped ease the patient’s concerns but allowed her physician to execute the appropriate treatment. If conservative care fails, MRN may support the use of surgical correction as well.

Conclusion: MR neurography is a useful tool in the setting of normal or equivocal standard imaging in patients with radicular pain. This case supports current evidence for this rarely used imaging modality.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/your-mri-is-normal-a-case-demonstrating-the-utility-of-mr-neurography-in-lumbar-radiculopathy/