Which imaging modalities are recommended for confirming the diagnosis of lumbar spinal stenosis in primary care?

Magnetic Resonance Imaging (MRI) is the recommended imaging modality for confirming the diagnosis of lumbar spinal stenosis in primary care due to its superior ability to visualise the neural foramina, lateral recesses, and central canal without ionising radiation exposure.

MRI provides detailed anatomical information about the degree and location of stenosis, which is critical for diagnosis and management planning.

While plain radiographs may be used initially to exclude other causes such as fractures or spondylolisthesis, they lack sensitivity for soft tissue and neural element assessment and are not sufficient to confirm lumbar spinal stenosis.

Computed Tomography (CT) can be considered if MRI is contraindicated or unavailable, as it offers good bony detail but is less effective than MRI in evaluating soft tissue structures.

This integrated approach aligns with UK clinical guidelines prioritising MRI for spinal canal evaluation and is supported by radiological literature demonstrating MRI’s superior diagnostic capability in lumbar spinal stenosis (Jinkins, 1999) ¹.