MRI of the Lumbar Spine: page 304 of ACOEM states, "Imaging studies should be reserved for cases in which surgery is considered or red flag diagnoses are being evaluated." On examination today this patient clearly demonstrated red flag findings (i.e., diminished unilateral reflex with diminished sensation in the same dermatome) that needs to be investigated via MRI. Page 290 of ACOEM defines red flag conditions as “… 4) radicular signs.” Therefore, MRI is clearly indicated.

MRI of the Cervical Spine: Chapter 8 (Neck & Upper back Complaints), page 178, in relevant part, states, “Unequivocal findings that identify specific nerve compromise on the neurologic examination are sufficient evidence to warrant imaging studies if symptoms persist.” As noted above, my neurological examination has found unequivocal findings for specific nerve root compromise and the patient continues to be symptomatic; therefore, please authorized the requested MRI of the cervical spine.