Mario Muto1, Francesco Giurazza2, Gianluigi Guarnieri1, Rossana Senese3, Emiliano Schena4, Fabio Zeccolini1, Alvaro Diano1. 1. Neuroradiology Department, Cardarelli Hospital, Naples, Italy. 2. Radiology Department, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, 00100, Rome, Italy. francescogiurazza@hotmail.it. 3. Emicenter European Medical Imaging, Casavatore, Naples, Italy. 4. Measurement and Biomedical Instrumentation Laboratory, Università Campus Bio-Medico di Roma, Rome, Italy.
Abstract
INTRODUCTION: This study aimed to determine changes in size of lumbar spinal canal and related articular structures, during dynamic MR scans acquired in symptomatic patients standing upright using a new open MR system. METHODS: Forty patients (mean age 58.4 years) affected by lumbar back pain associated with claudication, referring symptoms since more than 6 months. No one underwent to previous spine surgery. MR scans were performed with a novel open 0.5-T scanner, patient supine and upright (90°). Lumbar lordotic angle, flavum ligament thickness, herniated discs, spinal canal area, spinal canal and dural sac antero-posterior diameters, and spinal alignment were measured and compared in both supine and upright positions. Mean scanning time was 43 min. RESULTS: All the considered parameters showed a statistically significant difference, except for lumbar lordotic angle. Mean percentage differences moving from supine to upright were +3.9 % for lumbar lordotic angle, +15 % for flavum ligament thickness, +16.2 % for sagittal disc bulge, -10.8 % for dural sac diameter, -13.1 % for spinal canal diameter, and -15.8 % for spinal canal area. In supine position, no patient presented with spondylolisthesis; moving to upright position, four patients showed spondylolisthesis (grade I). CONCLUSION: Dynamic MR is a valuable diagnostic exam to analyze the structures involved in lumbar back pain due to spinal canal stenosis and spondylolisthesis; in supine position, relevant factors can be underestimated or hidden, becoming appreciable only patient standing upright. In this series, flavum ligament thickening presented a role comparable to disc bulge for narrowing of lumbar spinal canal.
INTRODUCTION: This study aimed to determine changes in size of lumbar spinal canal and related articular structures, during dynamic MR scans acquired in symptomatic patients standing upright using a new open MR system. METHODS: Forty patients (mean age 58.4 years) affected by lumbar back pain associated with claudication, referring symptoms since more than 6 months. No one underwent to previous spine surgery. MR scans were performed with a novel open 0.5-T scanner, patient supine and upright (90°). Lumbar lordotic angle, flavum ligament thickness, herniated discs, spinal canal area, spinal canal and dural sac antero-posterior diameters, and spinal alignment were measured and compared in both supine and upright positions. Mean scanning time was 43 min. RESULTS: All the considered parameters showed a statistically significant difference, except for lumbar lordotic angle. Mean percentage differences moving from supine to upright were +3.9 % for lumbar lordotic angle, +15 % for flavum ligament thickness, +16.2 % for sagittal disc bulge, -10.8 % for dural sac diameter, -13.1 % for spinal canal diameter, and -15.8 % for spinal canal area. In supine position, no patient presented with spondylolisthesis; moving to upright position, four patients showed spondylolisthesis (grade I). CONCLUSION: Dynamic MR is a valuable diagnostic exam to analyze the structures involved in lumbar back pain due to spinal canal stenosis and spondylolisthesis; in supine position, relevant factors can be underestimated or hidden, becoming appreciable only patient standing upright. In this series, flavum ligament thickening presented a role comparable to disc bulge for narrowing of lumbar spinal canal.
Authors: Guglielmo Manenti; Giovanni Liccardo; Gianluigi Sergiacomi; Luigi Ferrante; Giancarlo D'Andrea; Daniel Konda; Bernardo Fraioli; Orazio Schillaci; Giovanni Simonetti; Salvatore Masala Journal: In Vivo Date: 2003 Sep-Oct Impact factor: 2.155
Authors: Todd W Vitaz; Christopher B Shields; George H Raque; Stephen G Hushek; Robert Moser; Neil Hoerter; Thomas M Moriarty Journal: South Med J Date: 2004-05 Impact factor: 0.954