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Mariúba ESDO, de Carvalho LR, Dos Santos Volpi M, Junior RSF, Sobreira ML. Adaptation of the Lumbar Spine From Orthostasis to Supine. Clin Spine Surg 2025:01933606-990000000-00488. [PMID: 40257098 DOI: 10.1097/bsd.0000000000001808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 02/17/2025] [Indexed: 04/22/2025]
Abstract
STUDY DESIGN Observational-ecologic study. INTRODUCTION Spine and pelvis undergo modifications in alignment so that the individual can maintain an orthostatic position, but to date there is no evidence as to the contribution of each lumbar segment and the change that occurs in them when moving from orthostasis to supine position. OBJECTIVE To identify the difference in the contribution of the lumbar segments and pelvis to the formation of lumbar lordosis in both positions (orthostasis and supine) and how each one alters in this change. SUMMARY OF BACKGROUND DATA lumbar lordosis adapts to the individual's body position and can be physiological or pathologic. MATERIALS AND METHODS Retrospective cohort study that included 174 patients: the segments total lumbar lordosis (LL), L1-L4, L4-S1, L4-L5, L5-S1, and sacral slope were measured on x-rays (orthostasis) and MRI (supine). We obtained the mean values, correlations and models proposed for the relationship between the values found. RESULTS The SS, LL, L1-L4, L4-S1, and L4-L5 had their angular value reduced, and L5-S1 had its contribution to lordosis significantly increased when lying down. Moderate and strong correlations were obtained between SS × LL, L1-L4 and L4-S1, and between LL versus L1-L4 and L4-S1 in both positions. When using linear regression, proposed models were obtained with a high coefficient of determination between LL versus SS, L1-L4 and L4-S1 in orthostasis, for the same measurements and SS versus L4-S1 in supine, as well as for lordosis when comparing the 2 positions. CONCLUSIONS The L5-S1 segment has no change in angular value when lying in supine and is thus the largest contributor to lordosis in supine. L1-L4 increases its angular value when standing in orthostasis, the position in which it is the greatest contributor to lordosis.
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Affiliation(s)
| | | | | | - Rui Seabra Ferreira Junior
- Botucatu Medical School
- Center for the Study of Venoms and Venomous Animals (CEVAP), UNESP-Univ Estadual Paulista, Botucatu/SP, Brazil
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Fang X, Cui M, Wang Y, Liu L, Lv W, Ye H, Liu G. Effects of axial loading and positions on lumbar spinal stenosis: an MRI study using a new axial loading device. Skeletal Radiol 2025; 54:199-208. [PMID: 38849534 DOI: 10.1007/s00256-024-04720-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE A new axial loading device was used to investigate the effects of axial loading and positions on lumbar structure and lumbar spinal stenosis. METHODS A total of 40 patients sequentially underwent 4 examinations: (1) the psoas-relaxed position MRI, (2) the extended position MRI, (3) the psoas-relaxed position axial loading MRI, (4) the extended position axial loading MRI. The dural sac cross-sectional area, sagittal vertebral canal diameter, disc height and ligamentum flavum thickness of L3-4, L4-5, L5-S1 and lumbar lordosis angle were measured and compared. A new device with pneumatic shoulder-hip compression mode was used for axial loading. RESULTS In the absence of axial loading, there was a significant reduction in dural sac cross-sectional area with extension only seen at the L3-4 (p = 0.033) relative to the dural sac area in the psoas-relaxed position. However, with axial loading, there was a significant reduction in dural sac cross-sectional area at all levels in both psoas-relaxed (L3-4, p = 0.041; L5-S1, p = 0.005; L4-5, p = 0.002) and extension (p < 0.001) positions. The sagittal vertebral canal diameter and disc height were significantly reduced at all lumbar levels with axial loading and extension (p < 0.001); however, in psoas-relaxed position, the sagittal vertebral canal diameter was only reduced with axial loading at L3-4 (p = 0.018) and L4-5 (p = 0.011), and the disc height was reduced with axial-loading at all levels (L3-4, p = 0.027; L5-S1, p = 0.001; L4-5, p < 0.001). The ligamentum flavum thickness and lumbar lordosis in extension position had a statistically significant increase compared to psoas-relaxed position with or without axial loading (p < 0.001). CONCLUSION Both axial loading and extension of lumbar may exacerbate lumbar spinal stenosis. Axial loading in extension position could maximally aggravate lumbar spinal stenosis, but may cause some patients intolerable. For those patients, axial loading MRI in psoas-relaxed position may be a good choice.
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Affiliation(s)
- Xingyu Fang
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Department of Radiology, the 305 Hospital of PLA, Beijing, 100017, China
| | - Mengqiu Cui
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yingwei Wang
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lin Liu
- Department of Radiology, the 305 Hospital of PLA, Beijing, 100017, China
| | - Wei Lv
- Department of Radiology, the 305 Hospital of PLA, Beijing, 100017, China
| | - Huiyi Ye
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Gang Liu
- Department of Radiology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
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Ulmi N, Wiesmann N, Egli M, Swanenburg J, Sutter R. Impact of posture and axial loading on lumbar intervertebral disc dimensions investigated by transabdominal ultrasound. Eur J Radiol 2024; 181:111729. [PMID: 39260210 DOI: 10.1016/j.ejrad.2024.111729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 09/01/2024] [Accepted: 09/05/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE To use transabdominal ultrasound (US) to investigate the impact of posture and axial loading on the lumbar intervertebral disc (IVD) dimensions in healthy adults. METHOD For this single-center, prospective cross-sectional study 54 healthy volunteers (mean age 23.76 ± 3, 26 men) underwent transabdominal US. Lumbar IVD dimensions (height, length, width) at the levels L3/4 and L4/5 were assessed in three test conditions: supine, standing, and standing position with additional axial load of 50 % body weight (standing+50%). Success rates for the longitudinal and transverse US acquisitions and IVD dimension measurements were determined. IVD dimensions were compared across test conditions using two-way repeated measures analysis of variance and post-hoc pairwise t-tests with Bonferroni correction. RESULTS The success rate for longitudinal and transverse US acquisition was 100 %. The overall success rate for IVD dimension measurement was 96.4 %, it was highest for IVD height (99.2 %) and lowest for IVD length (93.3 %). IVD height at L4/5 decreased significantly from the supine to standing position (p < 0.05) and from the supine to standing+50% position (p < 0.01). IVD width at L3/4 increased significantly from the supine to standing+50% position (p < 0.05). No significant differences were found for IVD length. CONCLUSIONS Transabdominal US is a feasible tool to investigate IVD dimensions at L3/4 and L4/5 in different postures and with axial loading. Posture and axial loading significantly influence IVD height and width, but not length.
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Affiliation(s)
- Nora Ulmi
- Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich. Forchstrasse 340, 8008 Zurich, Switzerland; Faculty of Medicine, University of Zurich. Pestalozzistrasse 3, 8032 Zurich, Switzerland.
| | - Niklas Wiesmann
- Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich. Forchstrasse 340, 8008 Zurich, Switzerland; Faculty of Biomedical Sciences, University of Italian Switzerland. Via Buffi 13, 6900 Lugano, Switzerland.
| | - Marcel Egli
- Institute of Medical Engineering, Space Biology Group, Lucerne University of Applied Sciences and Arts. Obermattweg 9, 6052 Hergiswil, Switzerland; Innovation Cluster Space and Aviation (UZH Space Hub), University of Zurich. Air Force Center. Überlandstrasse 271, 8600 Dübendorf, Switzerland.
| | - Jaap Swanenburg
- Integrative Spinal Research ISR, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich. Forchstrasse 340, 8008 Zurich, Switzerland; Innovation Cluster Space and Aviation (UZH Space Hub), University of Zurich. Air Force Center. Überlandstrasse 271, 8600 Dübendorf, Switzerland; Institute of Anatomy, Faculty of Medicine, University of Zurich. Pestalozzistrasse 3, 8032 Zurich, Switzerland.
| | - Reto Sutter
- Faculty of Medicine, University of Zurich. Pestalozzistrasse 3, 8032 Zurich, Switzerland; Department of Radiology, Balgrist University Hospital, University of Zurich. Forchstrasse 340, 8006 Zurich, Switzerland.
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Şimşek AT, Baysal B, Adam BE, Çalış F, Topçam A, Demirkol M, Doğan MB, Binguler AHE, Karaarslan N, Balak N. Morphological changes after open lumbar microdiscectomy at 2-year follow-up. J Back Musculoskelet Rehabil 2024; 37:75-87. [PMID: 37599519 DOI: 10.3233/bmr-220371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND It is known that a possible decrease in disc height (DH) and foraminal size after open lumbar microdiscectomy (OLM) may cause pain in the long term. However, there is still insufficient information about the short- or long-term pathoanatomical and morphological effects of microdiscectomy. For example, the exact temporal course of the change in DH is not well known. OBJECTIVE The purpose of this study was to examine morphological changes in DH and foramen dimensions after OLM. METHODS In patients who underwent OLM for single-level lumbar disc herniation, MRI scans were obtained before surgery, and at an average of two years after surgery. In addition to DH measurements, foraminal area (FA), foraminal height (FH), superior foraminal width (SFW), and inferior foraminal width (IFW), were measured bilaterally. RESULTS A postoperative increase in DH was observed at all vertebral levels, with an average of 5.5%. The mean right FHs were 15.3 mm and 15.7 mm before and after surgery, respectively (p= 0.062), while the left FHs were 14.8 mm and 15.8 mm before and after surgery (p= 0.271). The mean right SFW was 5.4 mm before surgery and 5.7 mm after surgery, while the mean right IFW ranged from 3.6 mm to 3.9 mm. The mean left SFW was 4.8 mm before surgery and 5.2 mm after surgery, while the mean left IFW ranged from 3.5 mm to 3.9 mm. Before surgery, the FAs were, on average, 77.1 mm2 and 75.6 mm2 on the right and left sides, respectively. At the 2-year follow-up, the mean FAs were 84.0 mm2 and 80.2 mm2 on the right and left sides, respectively. CONCLUSIONS Contrary to prevalent belief, in patients who underwent single-level unilateral OLM, we observed that there may be an increase rather than a decrease in DH or foramen size at the 2-year follow-up. Our findings need to be confirmed by studies with larger sample sizes and longer follow-ups.
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Affiliation(s)
- Abdullah Talha Şimşek
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Begümhan Baysal
- Department of Radiology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Baha Eldin Adam
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Fatih Çalış
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Arda Topçam
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mahmut Demirkol
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mahmut Bilal Doğan
- Department of Radiology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayse Hande Erol Binguler
- Department of Industrial Engineering, Faculty of Engineering, Marmara University, Istanbul, Turkey
| | - Numan Karaarslan
- Department of Neurosurgery, Istanbul Haliç University, Istanbul, Turkey
| | - Naci Balak
- Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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Feldle P, Grunz JP, Kunz AS, Patzer TS, Huflage H, Hendel R, Luetkens KS, Ergün S, Bley TA, Conrads N. Weight-bearing gantry-free cone-beam CT of the lumbar spine: Image quality analysis and dose efficiency. Eur J Radiol 2023; 165:110951. [PMID: 37379623 DOI: 10.1016/j.ejrad.2023.110951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE The effect of static forces under load limits the prognostic value of lumbar spine CT in a horizontal position. Using a gantry-free scanner architecture, this study was designed to assess the feasibility of weight-bearing cone-beam CT (CBCT) of the lumbar spine and to establish the most dose-effective combination of scan parameters. METHODS Eight formalin-fixated cadaveric specimens were examined with a gantry-free CBCT system in upright position with the aid of a dedicated positioning backstop. Cadavers were scanned with eight combinations of tube voltage (102 or 117 kV), detector entrance dose level (high or low), and frame rates (16 or 30 fps). Five radiologists independently analyzed datasets for overall image quality and posterior wall assessability. Additionally, image noise and signal-to-noise ratio (SNR) were compared based on region-of-interest (ROI) measurements in the gluteal muscles. RESULTS Radiation dose ranged from 6.8 ± 1.6 (117 kV, dose level low, 16 fps) to 24.3 ± 6.3 mGy (102 kV, dose level high, 30 fps). Both image quality and posterior wall assessability were favored with 30 over 16 fps (all p ≤ 0.008). In contrast, both tube voltage (all p > 0.999) and dose level (all p > 0.096) did not significantly impact reader assessment. Image noise decreased considerably with higher frame rates (all p ≤ 0.040), while SNR ranged from 0.56 ± 0.03 to 1.11 ± 0.30 without a significant difference between scan protocols (all p ≥ 0.060). CONCLUSIONS Employing an optimized scan protocol, weight-bearing gantry-free CBCT of the lumbar spine allows for diagnostic imaging at reasonable radiation dose.
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Affiliation(s)
- Philipp Feldle
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Andreas Steven Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Theresa Sophie Patzer
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Robin Hendel
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Karsten Sebastian Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Süleyman Ergün
- Institute of Anatomy and Cell Biology, University of Würzburg, Koellikerstraße 6, 97070 Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Nora Conrads
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
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Changes in the lumbar intervertebral foramen between supine and standing posture in patients with adult spinal deformity: a study with upright computed tomography. Skeletal Radiol 2023; 52:215-224. [PMID: 36114881 DOI: 10.1007/s00256-022-04185-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantitatively assess the impact of supine and standing positions on the morphological changes in the lumbar intervertebral foramen (LIF) in patients with adult spinal deformity (ASD) using upright CT and conventional supine CT. MATERIALS AND METHODS Thirty patients with ASD were prospectively enrolled in this study. All subjects underwent standing whole spine posterior/anterior radiographs, lateral radiographs, and whole spine CT, both in the supine and upright standing positions. Two orthopedic surgeons independently measured nine radiographic parameters in the radiograph and the lumbar foraminal area (FA) and height (FH) in supine and upright CT. Statistical analyses were performed to evaluate the risk of LIF decrease when standing upright compared to the supine position. The chi-squared, t test, Pearson's coefficients, intra- and inter-rater reliabilities, and ROC curves were calculated. The level of significance was set at p < 0.05. RESULTS Among the 300 LIFs, both the lumbar FA and FH were either increased or decreased by > 5% in approximately 30% of LIFs each. The FA decreased in the lower lumbar spine. The concave side had a significantly higher rate of decreased FA and FH than the convex side (p < 0.05 and < 0.05, respectively). ROC analysis showed that narrowing of the intervertebral disc (cutoff > 0.05°) is a risk factor for decreased FA and FH. CONCLUSIONS This study describes the details of the changes in the neuroforamen using a novel upright CT. In patients with ASD, approximately 30% of LIFs either increased or decreased in size by > 5% when standing. The risk factors for LIF decrease are the lower lumbar spine, concave side, and narrow side of the disc wedge.
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Kurokawa H, Kosugi S, Fujinuma T, Oishi Y, Miyamoto T, Taniguchi A, Takemura H, Tanaka Y. Evaluation of Subtalar Joint’s Compensatory Function in Varus Ankle Osteoarthritis Using Globally Optimal Iterative Closest Points (Go-ICP). FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221103584. [PMID: 35782686 PMCID: PMC9247379 DOI: 10.1177/24730114221103584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: A previous study on 2-dimensional evaluation of the subtalar joint
functioning in varus ankle osteoarthritis concluded that varus deformity was
compensated for by the subtalar joint during early stages but not in the
advanced stages. Although compensatory function is expected both along the
axial and coronal planes, compensatory function in all 3 dimensions (3D)
remains unevaluated. This study evaluated the 3D-compensatory function of a
varus subtalar joint using Globally Optimal Iterative Closest Points
(Go-ICP), a 3D-shape registration algorithm, after 3D-bone shape
reconstruction using computed tomography. Methods: This study included 22 ankles: 4 stage 2 ankles, 5 stage 3a ankles, 6 stage
3b ankles, and 4 stage 4 ankles, categorized according to the
Takakura-Tanaka classification. As the control group, 3 ankles without prior
ankle injuries and disorders and 4 stage 2 ankles were included. One control
ankle was used as a reference. Relative values compared with the reference
ankle were evaluated in each group using Go-ICP. Each axis was set so that
dorsiflexion, valgus, and abduction were positive on the X axis, Y axis, and
Z axis, respectively. Results: Rotation angles of the talus (Rotation T) and calcaneus (Rotation C) on the Y
axis in the control and stage 3b were −7.6, −28, −2.1, and −13 degrees,
respectively, indicating significant differences. Value of Rotation
T-Rotation C (Rotation T-C) represents compensatory function of the subtalar
joint. In all ankles, there was a correlation between Rotation T and
Rotation T-C on the Y axis and Z axis (P < .01,
r = 0.84; P < .01, r
= −0.84, respectively). There was a correlation between
Rotation T values on the on Y and Z axes (P = .01,
r = 0.53). Conclusion: In varus ankle osteoarthritis, the talus had varus deformity with adduction.
Compensatory function in the coronal plane persisted, even in the advanced
stages; however, it was not sufficiently maintained in stage 3b.
Furthermore, compensatory function in the axial plane was relatively
sustained. Level of Evidence: Level III, retrospective comparative study.
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Affiliation(s)
| | | | | | - Yuya Oishi
- Tokyo University of Science, Noda, Chiba, Japan
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Lorenc T, Gołębiowski M, Michalski W, Glinkowski W. High-resolution, three-dimensional magnetic resonance imaging axial load dynamic study improves diagnostics of the lumbar spine in clinical practice. World J Orthop 2022; 13:87-101. [PMID: 35096539 PMCID: PMC8771416 DOI: 10.5312/wjo.v13.i1.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/02/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The response to axial physiological pressure due to load transfer to the lumbar spine structures is among the various back pain mechanisms. Understanding the spine adaptation to cumulative compressive forces can influence the choice of personalized treatment strategies.
AIM To analyze the impact of axial load on the spinal canal’s size, intervertebral foramina, ligamenta flava and lumbosacral alignment.
METHODS We assessed 90 patients using three-dimensional isotropic magnetic resonance imaging acquisition in a supine position with or without applying an axial compression load. Anatomical structures were measured in the lumbosacral region from L1 to S1 in lying and axially-loaded magnetic resonance images. A paired t test at α = 0.05 was used to calculate the observed differences.
RESULTS After axial loading, the dural sac area decreased significantly, by 5.2% on average (4.1%, 6.2%, P < 0.001). The intervertebral foramina decreased by 3.4% (2.7%, 4.1%, P < 0.001), except for L5-S1. Ligamenta flava increased by 3.8% (2.5%, 5.2%, P < 0.001), and the lumbosacral angle increased.
CONCLUSION Axial load exacerbates the narrowing of the spinal canal and intervertebral foramina from L1-L2 to L4-L5. Cumulative compressive forces thicken ligamenta flava and exaggerate lumbar lordosis.
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Affiliation(s)
- Tomasz Lorenc
- Ist Department of Clinical Radiology, Medical University of Warsaw, Warsaw 02-004, Poland
| | - Marek Gołębiowski
- Ist Department of Clinical Radiology, Medical University of Warsaw, Warsaw 02-004, Poland
| | - Wojciech Michalski
- Department of Mathematical Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw 02-781, Poland
| | - Wojciech Glinkowski
- Center of Excellence “TeleOrto” for Telediagnostics and Treatment of Disorders and Injuries of the Locomotor System, Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw 00-581, Poland
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Charoensuk J, Laothamatas J, Sungkarat W, Worapruekjaru L, Hooncharoen B, Chousangsuntorn K. Axial loading during supine MRI for improved assessment of lumbar spine: comparison with standing MRI. Acta Radiol 2021; 64:217-227. [PMID: 34939453 DOI: 10.1177/02841851211068148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- Jarruwat Charoensuk
- Department of Mechanical Engineering, School of Engineering, King Mongkut’s Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Jiraporn Laothamatas
- Faculty of Health Sciences Technology, HRH Princess Chulabhorn College of Medical Science, Bangkok, Thailand
| | - Witaya Sungkarat
- Department of Radiology and Advanced Diagnostic Imaging Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ladawan Worapruekjaru
- Division of Radiation Oncology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Boonthida Hooncharoen
- Advanced Diagnostic Imaging Center (AIMC), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Khaisang Chousangsuntorn
- Department of Radiological Technology, Faculty of Medical Technology, Mahidol University, Salaya, Nakhon Pathom, Thailand
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Kurokawa H, Taniguchi A, Miyamoto T, Tanaka Y. The Relationship Between the Distal Tibial Fibular Syndesmosis and the Varus Deformity in Patients With Varus Ankle Osteoarthritis. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211041111. [PMID: 35097473 PMCID: PMC8554566 DOI: 10.1177/24730114211041111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The impact of varus ankle osteoarthritis (OA) on the distal tibial fibular syndesmosis is poorly described. This study aimed to investigate the possible relationship between the condition of the distal tibial fibular syndesmosis and the degree of the varus deformity using weightbearing simulated computed tomography (CT), in patients with varus ankle OA. Methods: This retrospective comparative study included 155 varus ankles, divided into 4 Takakura-Tanaka groups (stage 2, 3a, 3b, and 4). A control group comprised 35 ankles without prior ankle disorders. The angles between the tibial shaft and the articular surface of the tibial plafond on the anteroposterior view (TAS), and articular surfaces of the tibial plafond and talar dome (TTW) were measured from weightbearing ankle radiographs. The varus angle of the ankle (VA) was defined as 90 – TAS + TTW. On the CT axial view, 1 cm proximal to the tibial plafond, the area of the syndesmosis (“CT-area”) and the distance between the fibula and the tibia (CT-FCS) were measured. Results: The CT area in stages 2, 3a, 3b, 4, and control group were 99, 79, 77, 103, and 97 mm2, respectively. The CT-FCS were 3.5, 3.1, 2.9, 4.3, and 3.9 mm, respectively. In all 155 OA ankles, CT area and CT-FCS were negatively correlated with the VA (correlation coefficient r = –0.38, P < .01; and r = 0.38, P < .01, respectively). Both CT area and CT-FCS were significantly smaller in stages 3a and 3b than in the control group (P < .01). Conclusion: There may be a relationship between the narrowing of the syndesmosis and the varus deformity in patients with varus ankle OA, especially in stages 3a and 3b. Clinical Relevance: Clinicians should be aware of the impact of varus ankle arthritis on the distal tibial fibular syndesmosis when operatively treating varus ankle OA. For some patients, the isolated treatment for the tibiotalar joint may be insufficient, and treatment for the syndesmosis as well as tibiotalar joint may be needed. Level of Evidence: Level III, retrospective case control study.
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Sungkarat W, Laothamatas J, Worapruekjaru L, Hooncharoen B, Charoensuk J, Chousangsuntorn K. Lumbosacral spinal compression device with the use of a cushion back support in supine MRI. Acta Radiol 2021; 62:1052-1062. [PMID: 32854529 DOI: 10.1177/0284185120951963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Witaya Sungkarat
- Department of Radiology and Advanced Diagnostic Imaging Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jiraporn Laothamatas
- Faculty of Health Sciences Technology, HRH Princess Chulabhorn College of Medical Science, Bangkok, Thailand
| | - Ladawan Worapruekjaru
- Division of Radiation Oncology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University
| | - Boonthida Hooncharoen
- Advanced Diagnostic Imaging Center (AIMC), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jarruwat Charoensuk
- Department of Mechanical Engineering, Faculty of Engineering, King Mongkut’s Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Khaisang Chousangsuntorn
- Department of Radiological Technology, Faculty of Medical Technology, Mahidol University, Phutthamonthon, Nakhon Pathom, Thailand
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In vivo 3D tomography of the lumbar spine using a twin robotic X-ray system: quantitative and qualitative evaluation of the lumbar neural foramina in supine and upright position. Eur Radiol 2020; 31:3478-3490. [PMID: 33119812 PMCID: PMC8043878 DOI: 10.1007/s00330-020-07355-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/27/2020] [Accepted: 09/16/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Supine lumbar spine examinations underestimate body weight effects on neuroforaminal size. Therefore, our purpose was to evaluate size changes of the lumbar neuroforamina using supine and upright 3D tomography and to initially assess image quality compared with computed tomography (CT). METHODS The lumbar spines were prospectively scanned in 48 patients in upright (3D tomographic twin robotic X-ray) and supine (30 with 3D tomography, 18 with CT) position. Cross-sectional area (CSA), cranio-caudal (CC), and ventro-dorsal (VD) diameters of foramina were measured by two readers and additionally graded in relation to the intervertebral disc height. Visibility of bone/soft tissue structures and image quality were assessed independently on a 5-point Likert scale for the 18 patients scanned with both modalities. Descriptive statistics, Wilcoxon's signed-rank test (p < 0.05), and interreader reliability were calculated. RESULTS Neuroforaminal size significantly decreased at all levels for both readers from the supine (normal intervertebral disc height; CSA 1.25 ± 0.32 cm2; CC 1.84 ± 0.24 cm2; VD 0.88 ± 0.16 cm2) to upright position (CSA 1.12 ± 0.34 cm2; CC 1.78 ± 0.24 cm2; VD 0.83 ± 0.16 cm2; each p < 0.001). Decrease in intervertebral disc height correlated with decrease in foraminal size (supine: CSA 0.88 ± 0.34 cm2; CC 1.39 ± 0.33 cm2; VD 0.87 ± 0.26 cm2; upright: CSA 0.83 ± 0.37 cm2, p = 0.010; CC 1.32 ± 0.33 cm2, p = 0.015; VD 0.80 ± 0.21 cm2, p = 0.021). Interreader reliability for area was fair to excellent (0.51-0.89) with a wide range for cranio-caudal (0.32-0.74) and ventro-dorsal (0.03-0.70) distances. Image quality was superior for CT compared with that for 3D tomography (p < 0.001; κ, CT = 0.66-0.92/3D tomography = 0.51-1.00). CONCLUSIONS The size of the lumbar foramina is smaller in the upright weight-bearing position compared with that in the supine position. Image quality, especially nerve root delineation, is inferior using 3D tomography compared to CT. KEY POINTS • Weight-bearing examination demonstrates a decrease of the neuroforaminal size. • Patients with higher decrease in intervertebral disc showed a narrower foraminal size. • Image quality is superior with CT compared to 3D tomographic twin robotic X-ray at the lumbar spine.
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Elshamly M, Windhager R, Toegel S, Grohs JG. Long-term impact of sagittal malalignment on hardware after posterior fixation of the thoracolumbar spine: a retrospective study. BMC Musculoskelet Disord 2020; 21:387. [PMID: 32546153 PMCID: PMC7298821 DOI: 10.1186/s12891-020-03405-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The importance of sagittal alignment in healthy individuals and in reconstructive spinal surgery has been studied over the last 15 years. The aim of the present study was to assess the long-term effects of abnormal sagittal alignment on hardware after posterior thoracolumbar spinal fusion. METHODS Patients who had undergone revision surgery (revision cohort, n = 34) due to breakage of their implants were compared retrospectively with patients who had intact implants at the final follow-up investigation after a long posterior thoracolumbar and/or lumbar spinal fusion (control cohort, n = 22). Clinical data and radiological parameters including the sagittal vertical axis (SVA), pelvic incidence (PI), lordosis gap (LG), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and the femoral obliquity angle (FOA) were assessed on full-spine lateral radiographs obtained in regular standing position. Data were analysed using descriptive statistics, parametric and non-parametric inferential statistics. RESULTS Patients in the breakage group (female n = 21, male n = 9, mean age 60.9 ± 15.6 years) had a higher anterior shift of the C7 plumb line (SVA) (p = 0.02), retroversion of the pelvis (PT) (p < 0.001), PI-LL mismatch (LG) (p = 0.001), and PI (p = 0.002) than the intact group (female n = 10, male n = 12, mean age 65.7 ± 12.4 years). No significant difference was registered between groups in regard of SS, LL, TK, FOA, and the mean number of comorbidities. CONCLUSION Failure of restoration of the SVA and the LG to the acceptable ranges, especially in patients with a high PI, may be regarded as a risk factor for the long-term failure of implants after posterior thoracolumbar spinal fusion.
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Affiliation(s)
- Mahmoud Elshamly
- Department of Orthopedics and Trauma Surgery, Division of orthopedics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
- Karl Chiari Lab for Orthopedic Biology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Division of orthopedics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
- Karl Chiari Lab for Orthopedic Biology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Stefan Toegel
- Karl Chiari Lab for Orthopedic Biology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
- Ludwig Boltzmann Cluster for Arthritis and Rehabilitation, Vienna, Austria
| | - Josef Georg Grohs
- Department of Orthopedics and Trauma Surgery, Division of orthopedics, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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Nouh MR. Imaging of the spine: Where do we stand? World J Radiol 2019; 11:55-61. [PMID: 31110605 PMCID: PMC6503457 DOI: 10.4329/wjr.v11.i4.55] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/11/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
The number of patients presenting with spine-related problems has globally increased, with an enormous growing demand for the use of medical imaging to address this problem. The last three decades witnessed great leaps for diagnostic imaging modalities, including those exploited for imaging the spine. These developments improved our diagnostic capabilities in different spinal pathologies, especially with multi-detector computed tomography and magnetic resonance imaging, via both hardware and software improvisations. Nowadays, imaging may depict subtle spinal instability caused by various osseous and ligamentous failures, and could elucidate dynamic instabilities. Consequently, recent diagnostic modalities can discern clinically relevant spinal canal stenosis. Likewise, improvement in diagnostic imaging capabilities revolutionized our understanding of spinal degenerative diseases via quantitative biomarkers rather than mere subjective perspectives. Furthermore, prognostication of spinal cord injury has become feasible, and this is expected to be translated into better effective patient tailoring to management plans with better clinical outcomes. Meanwhile, our confidence in diagnosing spinal infections and assessing the different spinal instrumentation has greatly improved over the past few last decades. Overall, revolutions in diagnostic imaging over the past few decades have upgraded spinal imaging from simple subjective and qualitative indices into a more sophisticated yet precise era of objective metrics via deploying quantitative imaging biomarkers.
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Affiliation(s)
- Mohamed R Nouh
- Faculty of Medicine, Alexandria University, Alexandria 21521, Egypt
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Outcome of Decompression Alone for Foraminal/Extraforaminal Entrapment of L5 Nerve Root Through Wiltse Paraspinal Approach. Clin Spine Surg 2017; 30:E1220-E1226. [PMID: 27977444 DOI: 10.1097/bsd.0000000000000486] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE OF THE STUDY The objective of the study was to present the surgical outcome and analyze the prognostic factors for postoperative leg pain after posterior decompression alone for foraminal/extraforaminal L5 entrapment at L5-S1 segment (LSS). SUMMARY OF BACKGROUND DATA Disk extrusion, hypertrophy of facet joint, osteophyte of vertebral body, thickened lumbosacral ligament, and collapsed disk lead to form the lumbosacral tunnel which compresses the L5 exiting nerve root. There are few reports discussing the outcome and prognostic factors of posterior decompression alone. MATERIALS AND METHODS One hundred two consecutive patients underwent posterior decompressive surgery through Wiltse approach for foraminal/extraforaminal entrapment at LSS, performed by 2 surgeons. Demography and preoperative radiograph were analyzed for 6 parameters: age, pathology, disk height, relative disk height ratio, depth of L5 vertebrae within the pelvis, and coronal wedging angle of the segment. Clinical outcomes were assessed by the Visual Analog Scale score for back and leg pain, Oswestry Disability Index, and modified Macnab criteria. The incidence of medications of anticonvulsants, opioids, epidural nerve root block and revisional surgery at index level were also examined. RESULTS This study included 93 patients. The mean follow-up period was 40.6±19.7 months. Thirty-six patients had disk herniation and 57 had stenosis. Preoperative Visual Analog Scale score and Oswestry Disability Index significantly improved at the final follow-up. On the basis of the modified Macnab criteria, 83% of the patients had good outcomes at follow-up. The mean duration of the medications of anticonvulsants or opioids is 27.2±37.4 days (0-210 d). 5 patients (5.4%) were reoperated. Relative disk height ratio <0.8 was associated with worsening of postoperative leg pain (P<0.01). CONCLUSIONS Decompression as the only method for foraminal/extraforminal lesion of LSS through Wiltse paraspinal approach provided good clinical results. A large difference of disk height between standing and supine positions is associated with poor clinical outcomes.
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Sato J, Ohtori S, Orita S, Yamauchi K, Eguchi Y, Ochiai N, Kuniyoshi K, Aoki Y, Nakamura J, Miyagi M, Suzuki M, Kubota G, Inage K, Sainoh T, Fujimoto K, Shiga Y, Abe K, Kanamoto H, Inoue G, Takahashi K. Answer to the Letter to the Editor of Wang Kai et al. concerning "Radiographic evaluation of indirect decompression of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lateral interbody fusion for degenerated lumbar spondylolisthesis" by Jun Sato et al. Eur Spine J (2017) 26:671-678. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:240-241. [PMID: 29058136 DOI: 10.1007/s00586-017-5326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Jun Sato
- Department of Orthopaedic Surgery, Chiba Aoba Municipal Hospital, 1273-2 Aobachou Chuo-ku, Chiba, Chiba, 260-0852, Japan. .,Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan.
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kazuyo Yamauchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Nobuyasu Ochiai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kazuki Kuniyoshi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Miyako Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Gou Kubota
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Takeshi Sainoh
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kazuki Fujimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Koki Abe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Hiroto Kanamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
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Dynamic MR in patients affected by neurogenical claudication: technique and results from a single-center experience. Neuroradiology 2016; 58:765-70. [DOI: 10.1007/s00234-016-1697-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/04/2016] [Indexed: 01/17/2023]
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Changes in lumbar spondylolisthesis on axial-loaded MRI: do they reproduce the positional changes in the degree of olisthesis observed on X-ray images in the standing position? Spine J 2015; 15:1255-62. [PMID: 25684062 DOI: 10.1016/j.spinee.2015.02.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 12/23/2014] [Accepted: 02/06/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Axial-loaded magnetic resonance imaging (MRI) can partially simulate the lumbar spine in patients in a standing position and potentially provides additional imaging findings that cannot be obtained with conventional MRI in the clinical assessment of patients with degenerative lumbar disease. Previous studies have shown that axial-loaded MRI demonstrates a significant reduction in the size of the dural sac compared with conventional MRI. However, there has been no study to compare the degree of olisthesis among conventional MRI, axial-loaded MRI, and upright X-ray imaging in patients with degenerative spondylolisthesis (DS). PURPOSE The purpose of the study is to determine whether axial-loaded MRI can demonstrate similar positional changes in lumbar olisthesis as those detected on upright lateral X-ray in patients with DS. STUDY DESIGN This is an imaging cohort study. PATIENT SAMPLE A total of 43 consecutive patients with DS exhibiting olisthesis of 3 mm or more on X-ray images in the standing position were prospectively evaluated in this study. OUTCOME MEASURES The degree of olisthesis, intraclass correlation coefficient (ICC), and percentage of patients exhibiting olisthesis of 3 mm or more on MRI. METHODS The degree of olisthesis was measured on conventional MRI, axial-loaded MRI, and lateral X-ray imaging performed in the upright position. The degree of olisthesis was compared among the three imaging techniques. The ICC values for the measurements of olisthesis between X-ray studies and conventional and axial-loaded MRI were calculated and compared. The percentage of patients exhibiting olisthesis of 3 mm or more was compared between conventional MRI and axial-loaded MRI. RESULTS The degree of olisthesis on axial-loaded MRI (5.9±2.5 mm) was significantly greater than that observed on conventional MRI (4.4±2.4 mm) (p<.05) although the degrees on conventional and axial-loaded MRI were significantly smaller than that on upright X-ray images (7.1±2.8 mm) (p<.05). The ICC between axial-loaded MRI and X-ray imaging (0.75, 95% confidence interval: 0.58-0.85) was considerably greater than that observed between conventional MRI and X-ray imaging (0.40, 95% confidence interval: 0.11-0.62). The percentage of patients exhibiting olisthesis of 3 mm or more was significantly higher on axial-loaded MRI (91%) than on conventional MRI (63%) (p<.01). CONCLUSIONS Axial-loaded MRI demonstrates a significantly larger degree of olisthesis than conventional MRI. In addition, the degree of olisthesis on axial-loaded MRI was found to be more strongly correlated with that observed on X-ray studies in the upright position. Furthermore, the use of axial-loaded MRI significantly reduced the misdiagnosis of olisthesis of 3 mm or more that was detected on X-ray imaging. These results suggest that axial-loaded MRI may be superior to identify the olisthesis of the lumbar spine and show the degrees of olisthesis correlated to those detected on upright X-ray imaging. Further studies should be needed to clarify the actual value of these findings on axial-loaded MRI and provide the evidence to support its clinical significance in the assessment of patients with DS.
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Abstract
STUDY DESIGN Feasibility study on the acquisition of lumbar spine kinematic data from upright magnetic resonance images obtained under heavy load carrying conditions. OBJECTIVE To characterize the effect of the load on spinal kinematics of active Marines under typical load carrying conditions from a macroscopic and lumbar-level approach in active-duty US Marines. SUMMARY OF BACKGROUND DATA Military personnel carry heavy loads of up to 68 kg depending on duty position and nature of the mission or training; these loads are in excess of the recommended assault loads. Performance and injury associated with load carriage have been studied; however, knowledge of lumbar spine kinematic changes is still not incorporated into training. These data would provide guidance for setting load and duration limits and a tool to investigate the potential contribution of heavy load carrying on lumbar spine pathologies. METHODS Sagittal T2 magnetic resonance images of the lumbar spine were acquired on a 0.6-T upright magnetic resonance imaging scanner for 10 active-duty Marines. Each Marine was scanned without load (UN1), immediately after donning load (LO2), after 45 minutes of standing (LO3) and walking (LO4) with load, and after 45 minutes of side-lying recovery (UN5). Custom-made software was used to measure whole spine angles, intervertebral angles, and regional disc heights (L1-S1). Repeated measurements analysis of variance and post hoc Sidak tests were used to identify significant differences between tasks (α = 0.05). RESULTS The position of the spine was significantly (P < 0.0001) more horizontal relative to the external reference frame and lordosis was reduced during all tasks with load. Superior levels became more lordotic, whereas inferior levels became more kyphotic. Heavy load induced lumbar spine flexion and only anterior disc and posterior intervertebral disc height changes were observed. All kinematic variables returned to baseline levels after 45 minutes of side-lying recovery. CONCLUSION Superior and inferior lumbar levels showed different kinematic behaviors under heavy load carrying conditions. These findings suggest a postural, lumbar flexion strategy aimed at centralizing a heavy posterior load over the base of support.
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Izzo R, Guarnieri G, Guglielmi G, Muto M. Biomechanics of the spine. Part II: Spinal instability. Eur J Radiol 2013; 82:127-38. [DOI: 10.1016/j.ejrad.2012.07.023] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 07/20/2012] [Accepted: 07/21/2012] [Indexed: 11/30/2022]
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