Functional Lumbarspine Magnetic Resonance Imaging in Uprightposition for Diagnosing Degenerative Disorders

Aim: to determine the capabilities of upright magnetic resonance imaging (MRI) in studying lumbar spine degenerative disorders. Materials and Methods. 58 patients were taken into the study(39 (67.4%), women, 19 (32.6%) men), aged 49.0 ± 13.7 years, suffering from chronic lumbar pain. The study was conducted using a 0.25 T MRI tomograph (G-Scan, Esaote, Italy) and included two parts. In the supine position T2-weigted images (WI) were performed (coronal, sagittal, axial); T1-WI and a sequence suppressing signal from fat tissue (STIR - short TR inversion recovery) in sagittal plane. Upright position protocols included T2-WI in the coronal, sagittal (slice sickness 4.5 mm, interval 5 mm) and axial planes. Results. In 100% cases sagittal disc dimensions showed to be increased in vertical position, which can be considered as typical disc changes. Excessive answer of these structures to the load with protrusion formation and excess of normal reaction by hernias and protrusions allowed to diagnose instability of interested spinal motion segments in 12.1%. In 100% cases characteristic lumbar spine static changes were revealed, such as the increase of physiological lordosis, pathological kyphosis appearance or tendency to develop it. In 10.2% cases vertebral-motion segments instability was revealed, characterized by augmented degree of vertebrae displacement in vertical position. Intervertebral joints' changes in 29.3% cases were described as articular processes' listhesis and synovial fluid movement inside the joint cavity. In 3 patients during verticalization a formation of absolute stenosis was revealed, as a result of vertebrae listhesis, increased herniation of intervertebral discs and ligamentumflava thickening. In 4 cases the upright examination couldn't be performed because of the appearance in patients of severe low back pain. Conclusion. In 22.3% cases this technique was able to suspect disc and vertebral-motion segments instability, as long as to precise the degree of central canal stenosis, which can all influence the choice of further management. MRI in upright position provided additional information in 91.1% of cases, which appeared to be clinically important in 22.3%.

магнитно-резонансная томография в вертикальном положении, поясничный отдел позвоночника, дегенеративные заболевания позвоночника, Weight-Bearing Magnetic Resonance Imaging, Lumbar Spine, Degenerative Disease of the Spine

1. Gallucci M., Puglielli E., Splendiani A. et al. Degenerative disorders of the spine. Eur. Radiol. 2005; 15 (3): 591-598.

2. Huang K.Y., Lin R.M., Lee Y.L., Li J.D. Factors affecting disability and physical function in degenerative lumbar spondylolisthesis of L4 - 5: evaluation with axially loaded MRI. Eur. Spine J. 2009; 18 (12): 1851-1857.

3. Tarantino U., Fanucci E., lundusi R. et al. Lumbar spine MRI in upright position for diagnosing acute and chronic low back pain: statistical analysis of morphological changes. J. Orthop. Traumatol. 2013; 14 (1):15-22.

4. Щедренок В.В., Яковенко И.В., Аникеев Н.В. и др. Малоинвазивная хирургия дегенеративных заболевания позвоночника. СПб.: РНХИ им. проф. А.Л. Поленова, 2011. 435 c.

5. Goethem J.W., Hauwe L.M., Parizel P.M. Spinal Imaging: Diagnostic Imaging of the Spine and Spinal Cord. Heidelberg: Springer, 2007. 581 p.

6. Hansson T., Suzuki N., Hebelka H., Gaulitz A. The narrowing of the lumbar spinal canal during loaded MRI: the effects of the disc and ligamentum flavum. Eur. Spine J. 2009; 18 (5): 679-686.

7. O'Connell G.D., Vresilovic E.J., Elliott D.M. Human intervertebral disc internal strain in compression: the effect of disc region, loading position, and degeneration. J. Orthop. Res. 2011; 29 (4): 547-555.

8. Бажин А.В., Егорова Е.А., Козлов А.Э. В Применение магнитно-резонансной томографии в вертикальном положении при исследовании поясничного отдела позвоночника. Радиология - практика. 2014; 2: 6-14.

9. Shymon S., Hargens A.R., Minkoff L.A., Chang D.G. Body posture and backpack loading: an upright magnetic resonance imaging study of the adult lumbar spine. Eur. Spine J. 2014. Epub: http://link.springer.com/article/10.1007%2Fs00586-014-3247-5.