Niladri Kumar Mahato1,2, Daryl Sybert3,4, Tim Law3,5,6,7, Brian Clark3,8,7. 1. Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH, USA. nm620511@ohio.edu. 2. Department of Biomedical Sciences, Ohio University, Athens, OH, USA. nm620511@ohio.edu. 3. Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, Athens, OH, USA. 4. Division of Orthopedic Surgery, OrthoNeuro, New Albany, OH, USA. 5. Department of Family Medicine, Ohio University, Athens, OH, USA. 6. Clinical and Translational Research Unit, Ohio University, Athens, OH, USA. 7. Department of Geriatric Medicine, Ohio University, Athens, OH, USA. 8. Department of Biomedical Sciences, Ohio University, Athens, OH, USA.
Abstract
PURPOSE: Our objective was to use an open weight-bearing MRI to identify the effects of different loading conditions on the inter-vertebral anatomy of the lumbar spine in a post-discectomy recurrent lumbar disc herniation patient. METHODS: A 43-year-old male with a left-sided L5-S1 post-decompression re-herniation underwent MR imaging in three spine-loading conditions: (1) supine, (2) weight-bearing on standing (WB), and (3) WB with 10 % of body mass axial loading (WB + AL) (5 % through each shoulder). A segmentation-based proprietary software was used to calculate and compare linear dimensions, angles and cross sections across the lumbar spine. RESULTS: The L5 vertebrae showed a 4.6 mm posterior shift at L5-S1 in the supine position that changed to an anterior translation >2.0 mm on WB. The spinal canal sagittal thickness at L5-S1 reduced from supine to WB and WB + AL (13.4, 10.6, 9.5 mm) with corresponding increases of 2.4 and 3.5 mm in the L5-S1 disc protrusion with WB and WB + AL, respectively. Change from supine to WB and WB + AL altered the L5-S1 disc heights (10.2, 8.6, 7.0 mm), left L5-S1 foramen heights (12.9, 11.8, 10.9 mm), L5-S1 segmental angles (10.3°, 2.8°, 4.3°), sacral angles (38.5°, 38.3°, 40.3°), L1-L3-L5 angles (161.4°, 157.1°, 155.1°), and the dural sac cross sectional areas (149, 130, 131 mm2). Notably, the adjacent L4-L5 segment demonstrated a retro-listhesis >2.3 mm on WB. CONCLUSION: We observed that with weight-bearing, measurements indicative of spinal canal narrowing could be detected. These findings suggest that further research is warranted to determine the potential utility of weight-bearing MRI in clinical decision-making.
PURPOSE: Our objective was to use an open weight-bearing MRI to identify the effects of different loading conditions on the inter-vertebral anatomy of the lumbar spine in a post-discectomy recurrent lumbar disc herniation patient. METHODS: A 43-year-old male with a left-sided L5-S1 post-decompression re-herniation underwent MR imaging in three spine-loading conditions: (1) supine, (2) weight-bearing on standing (WB), and (3) WB with 10 % of body mass axial loading (WB + AL) (5 % through each shoulder). A segmentation-based proprietary software was used to calculate and compare linear dimensions, angles and cross sections across the lumbar spine. RESULTS: The L5 vertebrae showed a 4.6 mm posterior shift at L5-S1 in the supine position that changed to an anterior translation >2.0 mm on WB. The spinal canal sagittal thickness at L5-S1 reduced from supine to WB and WB + AL (13.4, 10.6, 9.5 mm) with corresponding increases of 2.4 and 3.5 mm in the L5-S1 disc protrusion with WB and WB + AL, respectively. Change from supine to WB and WB + AL altered the L5-S1 disc heights (10.2, 8.6, 7.0 mm), left L5-S1 foramen heights (12.9, 11.8, 10.9 mm), L5-S1 segmental angles (10.3°, 2.8°, 4.3°), sacral angles (38.5°, 38.3°, 40.3°), L1-L3-L5 angles (161.4°, 157.1°, 155.1°), and the dural sac cross sectional areas (149, 130, 131 mm2). Notably, the adjacent L4-L5 segment demonstrated a retro-listhesis >2.3 mm on WB. CONCLUSION: We observed that with weight-bearing, measurements indicative of spinal canal narrowing could be detected. These findings suggest that further research is warranted to determine the potential utility of weight-bearing MRI in clinical decision-making.
Authors: John W Gilbert; J Chad Martin; Greg R Wheeler; Benjamin B Storey; Gregory E Mick; Gay B Richardson; Stephanie L Herder; Kwadwo Gyarteng-Dakwa; Patricia G Broughton Journal: J Manipulative Physiol Ther Date: 2010-10 Impact factor: 1.437