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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 and axial planes. a, c Clinostatism; b, d orthostasis. c Presence of a fluid collection between articular facets at L4–L5 (arrow). d Orthostatic position shows evagination of pseudocystic appearAnce of the right joint capsule with an impression on the nerve root and dural sac (arrowhead)
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Fig9: Fast spin echo (FSE) T2-weighted magnetic resonance images (MRI) in the sagittal and axial planes. a, c Clinostatism; b, d orthostasis. c Presence of a fluid collection between articular facets at L4–L5 (arrow). d Orthostatic position shows evagination of pseudocystic appearAnce of the right joint capsule with an impression on the nerve root and dural sac (arrowhead)

Mentions: Pathological changes were found in all patients. The most common findings were disc protrusions (44), disc herniations (12), facet-joint pathologies (10), spondylolisthesis (4), spinal canal stenosis (1), and pseudocysts of the joint capsules (3). Upright MRI showed a significant volumetric increase of disc protrusions than standard MRI. Moreover, upright MRI demonstrated disc protrusions in 11 patients with negative findings in supine position (Fig. 8a, b). In one case, a pseudocyst of the facet joint leading to a compressive effect on the nerve root was found in the standing position only (Fig. 9a–d).Fig. 8


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 and axial planes. a, c Clinostatism; b, d orthostasis. c Presence of a fluid collection between articular facets at L4–L5 (arrow). d Orthostatic position shows evagination of pseudocystic appearAnce of the right joint capsule with an impression on the nerve root and dural sac (arrowhead)
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3585839&req=5

Fig9: Fast spin echo (FSE) T2-weighted magnetic resonance images (MRI) in the sagittal and axial planes. a, c Clinostatism; b, d orthostasis. c Presence of a fluid collection between articular facets at L4–L5 (arrow). d Orthostatic position shows evagination of pseudocystic appearAnce of the right joint capsule with an impression on the nerve root and dural sac (arrowhead)
Mentions: Pathological changes were found in all patients. The most common findings were disc protrusions (44), disc herniations (12), facet-joint pathologies (10), spondylolisthesis (4), spinal canal stenosis (1), and pseudocysts of the joint capsules (3). Upright MRI showed a significant volumetric increase of disc protrusions than standard MRI. Moreover, upright MRI demonstrated disc protrusions in 11 patients with negative findings in supine position (Fig. 8a, b). In one case, a pseudocyst of the facet joint leading to a compressive effect on the nerve root was found in the standing position only (Fig. 9a–d).Fig. 8

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