Imaging in Radiculopathy Jose Mena, MD*, Andrew L. Sherman, MD All patients presenting with signs and symptoms of lumbar radiculopathy must undergo a thorough history taking and physical examination. After reviewing the dermatomal and myotomal patterns of the condition, astute clinicians often think that they are able to make the diagnosis. Often however, the diagnosis remains unclear; it is accurate anatomically, but the underlying cause of the lesion is not confirmed or the symptoms are so severe that more information on the anatomy is required. Finally, the patient may present with red flags that suggest that the cause of their condition is not benign. Therefore, often, the next step in the diagnostic process is to order imaging studies to attempt to confirm the suspected diagnosis or rule out more serious pathologic condition. There are several imaging examinations that are used as an extension of history taking and physical examination, including plain radiographs, magnetic resonance imaging (MRI), computed tomography (CT), CT myelogram, selective nerve root block, and bone scan. PLAIN RADIOGRAPHS Plain radiographs of the spine usually consist of anteroposterior and lateral views. Specialized circumstances, such as the suspicion of spondylolysis, require oblique views. Inquires into alignment and instability requires dynamic flexion/extension motion views (Figs. 1 and 2). Spine radiographs can also investigate whether the primary source of the spinal pain is related to malignancies, infections, instability, inflammatory spondyloarthropathies, and fractures (osteoporotic or pathologic) but with a lesser sensitivity than other imaging studies. 1 Osteophyte formation from zygapophyseal joints or severe spondylolisthesis may raise concern about nerve root impingement, but this must be confirmed by more detailed imaging, such as CT scan or MRI. 2 Although many clinicians most often recommend radiographs as the first-line imaging study to investigate spinal pain, 3 a lot has been written about the lack of The authors have nothing to disclose. Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, PO Box 016960 (D-461), Miami, FL 33101, USA * Corresponding author. E-mail address: jmena@med.miami.edu KEYWORDS  Diagnostic imaging  Spine  Radiculopathy  Rehabilitation Phys Med Rehabil Clin N Am 22 (2011) 41–57 doi:10.1016/j.pmr.2010.10.004 pmr.theclinics.com 1047-9651/11/$ – see front matter. Published by Elsevier Inc.