PET/MRI Imaging of Neuraxial Inflammation in Sciatica Patients

The purpose of this study is to determine if inflammation around the spinal nerves can be identified using a radioactive tracer [11C] PBR28 and integrated PET/MRI scan for the purpose of better treating patients who have radicular lumbar pain with epidural steroid injections.

Inclusion criteria

for pain subjects:

• Subject is 18-75 years old.
• Subject is able to give written informed consent.
• Subject is currently diagnosed with lower extremity radicular pain regardless of specific or suspected etiologies.
• Subject has a clear dermatomal distribution of the painful area extending to the distal lower extremities.
• Subject reports ongoing pain intensity of 4 or greater using the visual analogue scale (VAS) during the week prior to enrollment.

Inclusion criteria

for healthy subjects:

• Subject is 18-75 years old.
• Subject is able to give written informed consent.
• Subject has no history of chronic back/spine pain.

Exclusion criteria

for all groups:

• Subject recently received a lumbar ESI (within 8 weeks).
• Subject starts new NSAID medication for pain during the study.
• Subject has predominantly axial low back pain.
• Subject has known pain condition secondary to hip joint arthritis.
• Subject is pregnant or breastfeeding.
• Subject has allergy to lidocaine.
• Subject is treated with chronic corticosteroid therapy.
• Subject is on anticoagulation therapy (i.e. Coumadin, Plavix, or Lovenox).
• Subject has a known bleeding disorder (i.e. hemophilia).
• Subject has uncontrolled high blood pressure [>170/100].
• Subject has a known heart condition.
• Subject has known inflammatory disease (i.e. inflammatory bowel disease; ankylosing spondylitis; etc.).
• Subject has known liver dysfunction or renal insufficiency or impaired elimination (Renal dysfunction is defined as eGFR < 60. Hepatic dysfunction is defined as LFTs ≥ 3x ULN).
• Subject has been hospitalized recently (within one month) for a major psychiatric disorder (i.e. major depression, bipolar disorder, schizophrenia, anxiety disorder, or psychosis).
• Subject has contraindications to MRI and PET scanning (i.e. presence of a cardiac pacemaker or pacemaker wires, metallic particles in the body, vascular clips in the head or previous neurosurgery, prosthetic heart valves, or claustrophobia).
• Subject had research-related radiation exposure in the last 12 months.
• Subject tests positive for use of illicit drugs, marijuana, or non-prescribed drugs.