Imaging of Posterior Element Axial Pain Generators. Facet Joints, Pedicles, Spinous Processes, Sacroiliac Joints, and Transitional Segments

The role of the posterior elements in generating axial back and neck pain is well established; the imaging detection of posterior element pain generators remains problematic. Morphologic imaging findings have proved to be nonspecific and are frequently present in asymptomatic patients. Edema, inflammation, and hypervascularity are more specific for sites of pain generation, but are often overlooked by imagers if physiologic imaging techniques such as fat-suppressed T2 or contrast-enhanced T1-weighted magnetic resonance imaging, radionuclide bone scanning with single-photon emission computed tomography (CT), or ¹⁸F-fluorodeoxyglucose positron emission tomography combined with CT are not used.