Axial loading during supine MRI for improved assessment of lumbar spine: comparison with standing MRI

2021 ◽  
pp. 028418512110681
Author(s):  
Jarruwat Charoensuk ◽  
Jiraporn Laothamatas ◽  
Witaya Sungkarat ◽  
Ladawan Worapruekjaru ◽  
Boonthida Hooncharoen ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Intervertebral Disc ◽  
Spinal Stenosis ◽  
Weight Bearing ◽  
Cross Sectional Area ◽  
Spinal Curvature ◽  
Sectional Area ◽  
Cross Sectional ◽  
Compression Device ◽  
Dural Sac

Background There are no studies comparing the morphologic changes of lumbar spines between supine axial-loaded and 90° standing magnetic resonance imaging (MRI) examinations of patients with spinal stenosis. Purpose To determine whether axial-loaded MRI using a compression device demonstrated similar morphology of intervertebral disc, dural sac, and spinal curvature as those detected by 90° standing MRI in individuals with suspected spinal stenosis. Material and Methods A total of 54 individuals suspected of having spinal stenosis underwent both axial-loaded and standing MRI studies. The outcome measures included seven radiologic parameters of the lumbar spine: measures of the intervertebral disc (i.e. cross-sectional area [DA], disc height [DH], and anteroposterior distance [DAP]), dural sac (cross-sectional area [DCSA]), spinal curvature (i.e. lumbar lordosis [LL] and L1-L3-L5 angle [LA]), and total lumbar spine height (LH). Results For agreement between the two methods, intraclass correlation coefficient (ICC) ≥ 0.8 was found for all seven radiologic parameters. Supine axial-loaded MRI underestimated LL but remained correlated (ICC = 0.83) with standing MRI. Minor differences between the two methods (≤5.0%) were observed in DA, DCSA, DAP, LA, and LH, while a major difference was observed in LL (8.1%). Conclusion Using a compression device with the conventional supine MRI to simulate weight-bearing on the lumbar spine generated MRI morphology, which was strongly correlated with those from a standing MRI.

Lumbosacral spinal compression device with the use of a cushion back support in supine MRI

2020 ◽  
pp. 028418512095196
Author(s):  
Witaya Sungkarat ◽  
Jiraporn Laothamatas ◽  
Ladawan Worapruekjaru ◽  
Boonthida Hooncharoen ◽  
Jarruwat Charoensuk ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Weight Bearing ◽  
Axial Loading ◽  
Standing Position ◽  
Spinal Curvature ◽  
Strongly Correlated ◽  
Cross Sectional ◽  
Compression Device ◽  
Dural Sac ◽  
Magnetic Resonance Imaging Mri

Background We hypothesized that axial-loaded magnetic resonance imaging (MRI), modified with the use of a cushion placed behind the lower back (i.e. BS-MRI method), would simulate the standing position more accurately than an axial-loaded MRI without a cushion back support (BS). Purpose To determine whether the BS-MRI method demonstrated similar morphologies on intervertebral disc (IVD), dural sac, and spinal curvature as those detected on 90° standing MRIs in individuals with suspected spinal stenosis. Material and Methods Twenty-five subjects underwent a BS-MRI, as well as axial-loaded and standing MRI studies. Outcome measures were four radiographic parameters of the lumbar spine: IVD height (DH); dural sac cross-sectional area (DCSA); and spinal curvature (i.e. lumbar lordosis [LL] and L1-L3-L5 angle [LA]). Results Major differences (>5%) between standing MRI and BS-MRI methods were observed in DCSA, DH, and LL. Major differences between standing and axial loaded MRIs were observed only in DCSA and LA. Although BS-MRIs demonstrate an image of the lumbar spine curvature (i.e. LA) which is closer to that when standing than axial-loaded MRIs, it is likely to overestimate both narrowing of dural sac and extent of LL. Conclusion Using a compression device with a BS to simulate weight-bearing on the lumbar spine is not recommended due to: (i) overestimation of the narrowing of the dural sac and extent of LL; and (ii) underestimation of loss of disc height. Supine axial-loading produced DCSA and DH which were strongly correlated with those detected with standing MRIs. Exceptions were that LL and LA were underestimated.

scholarly journals Comparison of MRI cross-sectional area and functions of core muscles among asymptomatic individuals with and without lumbar intervertebral disc degeneration

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Gyeong-tae Gwak ◽  
Ui-jae Hwang ◽  
Sung-hoon Jung ◽  
Hyun-a Kim ◽  
Jun-hee Kim ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Intervertebral Disc ◽  
Disc Degeneration ◽  
Intervertebral Disc Degeneration ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Endurance Test ◽  
Cross Sectional ◽  
Significant Difference ◽  
Asymptomatic Individuals

Abstract Background Previous studies suggested that patients with symptomatic intervertebral disc degeneration (IDD) of lumbar spine have reduced cross-sectional area (CSA) and functions of core muscles. However, reduced CSA and functions of core muscles have been observed not only in patients with symptomatic IDD but also in patients with other subgroups of low back pain (LBP). Thus, it is uncertain whether reduced CSA and functions of core muscles lead to IDD and LBP, or pain leads to reduced CSA and functions of core muscles in patients with symptomatic IDD. Therefore, this study aimed to compare the CSA and functions of core muscles between asymptomatic participants with and without IDD in magnetic resonance imaging (MRI). Methods Twenty asymptomatic participants (12 men and 8 women) participated in this study. Ten participants had asymptomatic IDD at L4–5. The others were healthy controls (without IDD at all levels of lumbar spine). The CSA of core muscles was measured using MRI. Maximal isometric trunk flexor strength and side bridge strength were measured by a Smart KEMA strength sensor. Trunk flexor endurance test, side bridge endurance test and plank endurance test were used to measure core endurance. Double legs loading test was used to measure core stability. Mann-Whitney U test was used to compare the differences between two groups. Results There were no significant differences in core muscle functions between the two groups (p > 0.05). Moreover, there was no significant difference in CSA between the two groups (p > 0.05). Conclusions There was no significant difference in CSA and core muscle functions between asymptomatic participants with and without IDD. These findings indicate that a degenerative or bulging disc in asymptomatic individuals has little effect on CSA and functions of core muscles, especially in young age. Therefore, the general core endurance test or strength test could not differentiate asymptomatic people with and without IDD of lumbar spine. Trial registration number Clinical Research information Service. KCT0004061. Registered 13 June 2019. retrospectively registered.

scholarly journals Reliability of preoperative MRI findings in patients with lumbar spinal stenosis

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Hasan Banitalebi ◽  
Ansgar Espeland ◽  
Masoud Anvar ◽  
Erland Hermansen ◽  
Christian Hellum ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Interobserver Agreement ◽  
Facet Joint ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Intraobserver Agreement ◽  
Mri Findings ◽  
Cross Sectional ◽  
Facet Joint Osteoarthritis ◽  
Dural Sac

Abstract Background Magnetic Resonance Imaging (MRI) is an important tool in preoperative evaluation of patients with lumbar spinal stenosis (LSS). Reported reliability of various MRI findings in LSS varies from fair to excellent. There are inconsistencies in the evaluated parameters and the methodology of the studies. The purpose of this study was to evaluate the reliability of the preoperative MRI findings in patients with LSS between musculoskeletal radiologists and orthopaedic spine surgeons, using established evaluation methods and imaging data from a prospective trial. Methods Consecutive lumbar MRI examinations of candidates for surgical treatment of LSS from the Norwegian Spinal Stenosis and Degenerative Spondylolisthesis (NORDSTEN) study were independently evaluated by two musculoskeletal radiologists and two orthopaedic spine surgeons. The observers had a range of experience between six and 13 years and rated five categorical parameters (foraminal and central canal stenosis, facet joint osteoarthritis, redundant nerve roots and intraspinal synovial cysts) and one continuous parameter (dural sac cross-sectional area). All parameters were re-rated after 6 weeks by all the observers. Inter- and intraobserver agreement was assessed by Gwet’s agreement coefficient (AC1) for categorical parameters and Intraclass Correlation Coefficient (ICC) for the dural sac cross-sectional area. Results MRI examinations of 102 patients (mean age 66 ± 8 years, 53 men) were evaluated. The overall interobserver agreement was substantial or almost perfect for all categorical parameters (AC1 range 0.67 to 0.98), except for facet joint osteoarthritis, where the agreement was moderate (AC1 0.39). For the dural sac cross-sectional area, the overall interobserver agreement was good or excellent (ICC range 0.86 to 0.96). The intraobserver agreement was substantial or almost perfect/ excellent for all parameters (AC1 range 0.63 to 1.0 and ICC range 0.93 to 1.0). Conclusions There is high inter- and intraobserver agreement between radiologists and spine surgeons for preoperative MRI findings of LSS. However, the interobserver agreement is not optimal for evaluation of facet joint osteoarthritis. Trial registration www.ClinicalTrials.gov identifier: NCT02007083, registered December 2013.

scholarly journals Dural Sac Cross-Sectional Area Does Not Correlate with Efficacy of Percutaneous Adhesiolysis in Single Level Lumbar Spinal Stenosis

2011 ◽  
Vol 4;14 (4;7) ◽  
pp. 277-282
Author(s):  
Dr. Chan Hong Park
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Cross Sectional Area ◽  
Low Back ◽  
Sectional Area ◽  
Cross Sectional ◽  
Epidural Steroid Injections ◽  
Dural Sac ◽  
Lumbar Spinal ◽  
Epidural Steroid

Background: Spinal stenosis is a narrowing of the spinal canal, which causes mechanical compression of spinal nerve roots. The compression of these nerve roots can cause low back pain and/or leg pain, as well as neurogenic claudication. Lumbar epidural steroid injections have commonly been used in patients with lumbar spinal stenosis (LSS). In cases that are refractory to epidural steroid injections, percutaneous epidural adhesiolysis has been used. Objective: The aim of our study is to determine the relationship between the severity of spinal stenosis and the participants’ response to adhesiolysis, and to evaluate the mid-term effectiveness of adhesiolysis. Study Design: A prospective observational study. Methods: Sixty-six patients with degenerative LSS were enrolled in this prospective study. All participants underwent lumbar spine magnetic resonance imaging (MRI). The cross-sectional area of the dural sac was measured on the transverse angled sections through the central part of the disc on conventional MR images. All percutaneous adhesiolyses were performed in the operating room. One hour following the procedure, 6 mL of 8% sodium chloride solution was infused during 30 minutes in the recovery room while the patient underwent monitoring. Outcome measures were obtained using the 5-point patient satisfaction scale at 2 weeks and 6 months post-treatment. To evaluate outcome predictors, we divided the participants into 2 groups according to their response to treatment. Limitations: Secondary outcomes were not measured and the study did not include a long-term follow-up period. Results: Improvement (including reports of slightly improved, much improved, and no pain) was observed in 49 participants (74.2%) at 2 weeks and 45 participants (66.7%) at 6 months after the procedure. The dural sac cross-sectional area (DSCSA) did not differ between participants who reported improvement and those who did not. There was no statistically significant correlation between pain relief and DSCSA, age, or participant sex. Conclusion: Percutaneous adhesiolysis was shown to be effective for the treatment of LSS, with mid-term result, without affecting DSCSA. Key words: Low back pain, lumbar spinal stenosis, failed back surgery syndrome, dural sac, interventional techniques, epidural injection, percutaneous adhesiolysis.

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