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Lumbar spine MRI in upright position for diagnosing acute and chronic low back pain: statistical analysis of morphological changes.

Tarantino U, Fanucci E, Iundusi R, Celi M, Altobelli S, Gasbarra E, Simonetti G, Manenti G - J Orthop Traumatol (2012)

Bottom Line: Statistically significant differences [one-way analysis of variance (ANOVA), p = 0.0043] were found between each pair of values of parameters sampled in recumbent and upright positions.In 70 % of patients, on visual qualitative analysis only, an increment of disc protrusions and/or spondylolisthesis was found in the upright position; in three cases, in the upright position only, an interarticular pseudocyst was found.Dynamic MRI with an open-configuration, low-field tilting MRI system is a feasible and promising tool to study degenerative pathology of the spine.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Traumatology, Tor Vergata University of Rome, Policlinico Tor Vergata Foundation, V.le Oxford 81, 00133, Rome, Italy.

ABSTRACT

Background: Patients with low back pain frequently demonstrate recumbent magnetic resonance imaging (MRI) alterations not always related to homogeneous clinical symptoms. The purpose of this study was to evaluate and quantify the statistical significance of variations of some anatomical parameters of the lumbosacral spine and reveal occult disc pathologies from recumbent to upright position in patients with acute and chronic low back pain.

Materials and methods: Fifty-seven patients complaining of low back pain (27 women, 30 men) underwent dynamic lumbosacral MRI with a 0.25-T tilting system (G-scan Esaote). We settled five parameters for which variations have been evaluated: lumbosacral angle, lordosis angle, L3-L4 intersomatic disc height, L3-L4 interspinous processes distance, and widest anteroposterior dural sac diameter. Images were obtained in both recumbent and upright positions.

Results: Statistically significant differences [one-way analysis of variance (ANOVA), p = 0.0043] were found between each pair of values of parameters sampled in recumbent and upright positions. In 70 % of patients, on visual qualitative analysis only, an increment of disc protrusions and/or spondylolisthesis was found in the upright position; in three cases, in the upright position only, an interarticular pseudocyst was found.

Conclusions: Dynamic MRI with an open-configuration, low-field tilting MRI system is a feasible and promising tool to study degenerative pathology of the spine. Moreover, in cases of low back pain with negative MRI in the recumbent position or in patients with pain in the upright position only, tilting MRI permits visualization of occult spine and disc pathologies in patients with acute or chronic low back pain.

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Fast spin echo (FSE) T2-weighted magnetic resonance images (MRI) in the sagittal plane. Lumbosacral angle and lumbar lordosis angle are average values. a Supine position: lumbosacral angle 136.7°, lordosis angle 35.5°. b Upright position: lumbosacral angle 131.7°, lordosis angle 41.6°
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Fig1: Fast spin echo (FSE) T2-weighted magnetic resonance images (MRI) in the sagittal plane. Lumbosacral angle and lumbar lordosis angle are average values. a Supine position: lumbosacral angle 136.7°, lordosis angle 35.5°. b Upright position: lumbosacral angle 131.7°, lordosis angle 41.6°

Mentions: Lumbosacral angle: This was defined as the anterior open-angle intercepted by two tangent lines of the anterior walls of L5 and S1 (Fig. 1a, b). The normal range for this angle is 120–180°. An increased angle corresponds to vertical tilting of the sacrum, which biomechanically produces an increased load on the anterior column and accelerates the degenerative processes of the L5–S1 disc. On the contrary, a decreased lumbosacral angle is associated with sacrum horizontalization, which consequently creates an amplified load on the posterior elements (facet joints).Fig. 1


Lumbar spine MRI in upright position for diagnosing acute and chronic low back pain: statistical analysis of morphological changes.

Tarantino U, Fanucci E, Iundusi R, Celi M, Altobelli S, Gasbarra E, Simonetti G, Manenti G - J Orthop Traumatol (2012)

Fast spin echo (FSE) T2-weighted magnetic resonance images (MRI) in the sagittal plane. Lumbosacral angle and lumbar lordosis angle are average values. a Supine position: lumbosacral angle 136.7°, lordosis angle 35.5°. b Upright position: lumbosacral angle 131.7°, lordosis angle 41.6°
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3585839&req=5

Fig1: Fast spin echo (FSE) T2-weighted magnetic resonance images (MRI) in the sagittal plane. Lumbosacral angle and lumbar lordosis angle are average values. a Supine position: lumbosacral angle 136.7°, lordosis angle 35.5°. b Upright position: lumbosacral angle 131.7°, lordosis angle 41.6°
Mentions: Lumbosacral angle: This was defined as the anterior open-angle intercepted by two tangent lines of the anterior walls of L5 and S1 (Fig. 1a, b). The normal range for this angle is 120–180°. An increased angle corresponds to vertical tilting of the sacrum, which biomechanically produces an increased load on the anterior column and accelerates the degenerative processes of the L5–S1 disc. On the contrary, a decreased lumbosacral angle is associated with sacrum horizontalization, which consequently creates an amplified load on the posterior elements (facet joints).Fig. 1

Bottom Line: Statistically significant differences [one-way analysis of variance (ANOVA), p = 0.0043] were found between each pair of values of parameters sampled in recumbent and upright positions.In 70 % of patients, on visual qualitative analysis only, an increment of disc protrusions and/or spondylolisthesis was found in the upright position; in three cases, in the upright position only, an interarticular pseudocyst was found.Dynamic MRI with an open-configuration, low-field tilting MRI system is a feasible and promising tool to study degenerative pathology of the spine.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Traumatology, Tor Vergata University of Rome, Policlinico Tor Vergata Foundation, V.le Oxford 81, 00133, Rome, Italy.

ABSTRACT

Background: Patients with low back pain frequently demonstrate recumbent magnetic resonance imaging (MRI) alterations not always related to homogeneous clinical symptoms. The purpose of this study was to evaluate and quantify the statistical significance of variations of some anatomical parameters of the lumbosacral spine and reveal occult disc pathologies from recumbent to upright position in patients with acute and chronic low back pain.

Materials and methods: Fifty-seven patients complaining of low back pain (27 women, 30 men) underwent dynamic lumbosacral MRI with a 0.25-T tilting system (G-scan Esaote). We settled five parameters for which variations have been evaluated: lumbosacral angle, lordosis angle, L3-L4 intersomatic disc height, L3-L4 interspinous processes distance, and widest anteroposterior dural sac diameter. Images were obtained in both recumbent and upright positions.

Results: Statistically significant differences [one-way analysis of variance (ANOVA), p = 0.0043] were found between each pair of values of parameters sampled in recumbent and upright positions. In 70 % of patients, on visual qualitative analysis only, an increment of disc protrusions and/or spondylolisthesis was found in the upright position; in three cases, in the upright position only, an interarticular pseudocyst was found.

Conclusions: Dynamic MRI with an open-configuration, low-field tilting MRI system is a feasible and promising tool to study degenerative pathology of the spine. Moreover, in cases of low back pain with negative MRI in the recumbent position or in patients with pain in the upright position only, tilting MRI permits visualization of occult spine and disc pathologies in patients with acute or chronic low back pain.

Show MeSH
Related in: MedlinePlus