Dynamic examination of the lumbar spine by using vertical, open magnetic resonance imaging

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Object. The aim of this study was to determine the relationship of different structures of the lower lumbar spine during interventional movement examination.

Methods. Clinically healthy volunteers and patients suffering from degenerative disorders of the lumbar spine underwent vertical, open magnetic resonance (MR) imaging (0.5 tesla). Three functional patterns of lumbar spine motion were identified in 50 healthy volunteers, (average age 25 years). The authors identified characteristic angles of the facet joints, as measured in the frontal plane. In 50 patients with degenerative disorders of the lumbar spine (41 with disc herniation, five with osteogenic spinal stenosis, and four with degenerative spondylolisthesis) the range of rotation was increased in the relevant spinal segments. Signs of neural compression were increased under motion.

Conclusions. Dynamic examination in which vertical, open MR imaging is used demonstrated that the extent of neural compression as well as the increasing range of rotation are important signs of segmental instability.

Article Information

Address reprint requests to: Hans-Ekkehart Vitzthum, M.D., Ph.D., Klinik für Neurochirurgie der Universität Leipzig, Johannisallee 34, D-04103 Leipzig, Germany. email: vithe@server3.medizin. uni-leipzig.de.

© AANS, except where prohibited by US copyright law.

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Figures

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    Photograph showing a patient in the 0.5-tesla superconducting MR system in a defined position (flexion, extension, and rotation). Magnetic resonance images are acquired for further investigations.

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    Photograph illustrating standard positions with defined motion of the spine (flexion—extension) and following characterization of the mobility of the lumbar vertebral bodies.

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    Standard position with a defined shoulder rotation is used to analyze further the degree of the axial mobility of adjacent vertebra.

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    Diagram showing the measurement of the angle between adjacent vertebrae in flexion—extension and definition as kyphotic or lordotic variation, as described by White and Panjabi.

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    Magnetic resonance images and illustrations depicting the segmental mobility as the degree of axial rotation of adjacent vertebrae.

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    Axial MR image demonstrating the measurement of facet joint angles and anteroposterior diameter of the spinal canal with an exactness of 1 mm.

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    Illustrations and corresponding MR images demonstrating functional patterns of the spine during anteflexion. Upper: A Type I pattern showing a harmonic kyphotic change of each of the examined intervertebral spaces. All segmental angles were positive between + 3° and + 8°. Center: Type II as an example of a negative segmental angle and a compensatory shift in the lowest lumbar segment after anteflexion. Lower: In Type III patterns the kyphotic change occurs in the L3–4 segment and the lordotic motion of the last two segments following anteflexion. Essential for the lordotic pattern of the lowest segments was the negative segmental angle.

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    Sagittal T2-weighted MR images of an L4–5 disc herniation obtained in a 42-year-old man, demonstrating the degenerative change of the lumbar disc and the narrowing of the disc space following herniation. The findings were reproducible during flexion—extension of the lumbar spine.

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    Axial T1-weighted MR images obtained in a 38-year-old man with a clinically and radiologically confirmed dorsomedial L4–5 disc herniation before (left) and after rotation (right).

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    Axial T2-weighted MR image demonstrating a typical case of L4–5 nerve root compression in a 50-year-old woman. The image demonstrates the asymmetrical facet joints and an accompanying shift in the ipsilateral facet joint to a more frontal position compared with the opposite side.

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    Sagittal T2-weighted MR images revealing degenerative L4–5 spondylolisthesis and intervertebral disc herniation. The images documented fixed pathological findings.

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