Table 3.

Diagnostic modalities for FBSS

Modality	Comments
History and physical examination	Assess for radicular symptoms, range of motion, paraspinal and SIJ tenderness, alleviating and exacerbating factors
X-ray	Assess for bony spinal deformities with flexion and extension images
MRI	Gadolinium-enhanced T1 is Gold standard for assessing soft tissue injuries. Assess for disc herniations, stenosis, and fibrosis
CT myelogram	Useful when implanted hardware creates artifact with MRI
CT with multiplanar reconstructions	Assess for osseous changes in the spine. Helpful for visualization of hardware
Discography	Helpful in isolating a specific intervertebral disc as source of back/leg pain
Diagnostic injections	Helpful in ruling in/out a specific nerve root or joint as cause of pain. Steroids may be added to provide sustained relief

Abbreviations: CT, computed tomography; FBSS, failed back surgery syndrome; MRI, magnetic resonance imaging; SIJ, sacroiliac joint.