Evaluation of Lumbar Conditions: A Comprehensive Guide for Accurate Diagnosis and Personalized Treatment

Who Should Undergo a Lumbar Evaluation?

Patients experiencing persistent or severe low back pain, especially when accompanied by symptoms such as:

• Radiating pain to legs (sciatica)
• Numbness or tingling in the lower limbs
• Difficulty walking or maintaining balance
• Bladder or bowel dysfunction
• Progressive muscular weakness

These symptoms may indicate the presence of spinal stenosis, disc herniation, tethered cord, or degenerative instability and should be evaluated by a specialist.

Step-by-Step: How We Evaluate Lumbar Spine Conditions

1. Detailed Medical History

A complete review of patient history helps identify potential congenital, traumatic, inflammatory or genetic factors. Patients with connective tissue disorders such as Ehlers-Danlos Syndrome (EDS) require special attention, as their presentations may be atypical.

2. Neurological Examination

Assessment includes reflexes, muscle strength, sensory testing and gait evaluation. Signs of radiculopathy or myelopathy are documented.

3. Advanced Imaging Protocols

In collaboration with our imaging partners, we use specialized technology including:

• Prone Lumbar 3T MRI with AI-based respiratory artifact correction
• Supine MRI
• CT and Cone-Beam CT (CBCT) for bony structure analysis

A normal supine MRI may miss subtle forms of instability. That is why prone imaging are critical in our diagnostic protocol.

“A prone and supine lumbar MRI allow us to compare both images. Obtaining a prone (face down) lumbar MRI with clear imaging is difficult as the prone position causes respiratory artifacts… In Barcelona we use a 3T MRI machine with artificial intelligence and special sequencing to produce clear images.”

4. Functional Testing

In cases involving suspected tethered cord or arachnoiditis, lumbar prone MRI and electromyography may be performed.

5. Clinical-Radiological Correlation

We don’t treat images—we treat patients. Imaging results are interpreted in the context of symptoms and clinical findings to avoid misdiagnosis or overtreatment.

“It is extremely important to compare the clinical-radiological correlation to determine the congruence between the clinical symptomatology and the imaging.”

Common Lumbar Conditions We Diagnose and Treat Degenerative Disc Disease (DDD)

A progressive deterioration of the intervertebral discs leading to pain, stiffness, and sometimes instability. Evaluation includes disc hydration, height loss, and Modic changes.

Lumbar Disc Herniation

Occurs when the nucleus pulposus protrudes through the annulus, compressing nerve roots. This is a common cause of sciatica and requires precise imaging to assess surgical necessity.

Spinal Stenosis

Narrowing of the spinal canal often due to ligamentum flavum hypertrophy, disc bulging, or osteophytes. Postural symptoms are key: patients often report relief when leaning forward.

Spondylolisthesis

The anterior slippage of one vertebra over another, which may be degenerative or isthmic and in EDS patients it can be due to its laxity. Evaluation must determine the stability and degree of slippage before indicating fusion surgery.

Tethered Cord Syndrome

Tethering of the spinal cord can produce symptoms mimicking degenerative disease. Proper prone imaging is essential, as supine MRIs may not detect it.

Facet Joint Pain and Instability

Often missed in standard evaluations. These small joints can cause axial back pain and are often involved in hypermobility syndromes.

The Role of Genetics, Inflammation, and Connective Tissue Disorders

Some patients present with symptoms disproportionate to standard imaging findings. In these cases, we explore:

• Genetic markers related to collagen structure
• Inflammatory biomarkers
• MCAD (Mast Cell Activation Disorders) that may exacerbate pain syndromes

This integrative approach allows us to avoid unnecessary surgeries and propose precise, often non-invasive alternatives.

“We specialize in the treatment of complex cases, combining evaluations from surgical, immunological and inflammatory perspectives to offer a holistic model of care.”

When Is Surgery Indicated?

Surgical options are reserved for severe or refractory cases. We perform procedures such as:

• Anterior lumbar disc replacement
• Transforaminal Lumbar Interbody Fusion (TLIF)
• Oblique Lateral Interbody Fusion (OLIF)
• Rhizolysis for facet-mediated pain
• Tethered cord release

Each case is individually discussed with the patient, including expectations, risks, and potential benefits.

“Surgery should be the last option. However, if symptoms significantly affect quality of life, surgery could be considered.”

Our Multidisciplinary Team

Dr. Vicenç Gilete leads a team composed of neurosurgeons, orthopedic spine surgeons, internal medicine specialists, radiologists, and pain management experts. The team is based in Teknon Hospital, one of Europe’s leading medical centers.

Remote Consultations and International Evaluations

We offer multiple options to evaluate your case:

• Submit your imaging remotely for review
• Book an in-person consultation in Barcelona
• Schedule imaging + consultation in one visit

“We provide both distance and in-person evaluation. Imaging can either be sent to us or obtained in Barcelona prior to your consultation.”

Frequently Asked Questions (FAQs)

What if my previous MRI was normal?

A normal supine MRI may not detect dynamic or positional abnormalities. We recommend prone/upright MRI with advanced sequencing.

Can lumbar instability cause bladder problems?

Yes. Especially in cases involving tethered cord or canal stenosis.

I have Ehlers-Danlos. Is this evaluation for me?

Absolutely. We specialize in hypermobility syndromes and tailor diagnostics accordingly.

How long does the evaluation take?

Initial imaging and consultation can be done in 1–2 days during your visit to Barcelona.

Can I be treated without surgery?

Many patients benefit from non-surgical treatments including neuromodulation, regenerative medicine, or targeted physiotherapy.

Conclusion

A proper evaluation of lumbar conditions is more than just an MRI. It’s a comprehensive, multidisciplinary process that should correlate clinical findings with advanced imaging and personal context. At DrGilete.com, our mission is to deliver precise, empathetic, and world-class care to patients suffering from complex spinal pathologies.

If you’re struggling with unresolved lumbar issues, contact us for a second opinion, submit your scans for review, or book an evaluation in Barcelona.