Changes in dural sac caliber with standing MRI improve correlation with symptoms of lumbar spinal stenosis

Lau, Yvonne Yan On; Lee, Ryan Ka Lok; Griffith, James F.; Chan, Carol Lai Yee; Law, Sheung Wai; Kwok, Kin On

doi:10.1007/s00586-017-5211-7

Cited by 21 publications

(20 citation statements)

References 44 publications

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“…25 This leads to the problems in diagnosing and choosing the treatment tactics. 7,18 Combined stenosis of the spinal canal has a reciprocal clinical complication both before surgery and in the postoperative period, due to prolonged positioning on the operating table. 26 Approaches to surgical treatment of patients with tandem stenoses are currently not sufficiently studied due to the symptom polymorphism and the multifactorial pathomorphological substrate, which cause narrowing of the spinal canal at several levels.…”

Section: Discussionmentioning

confidence: 99%

“…The criteria for comparison of clinical neurological symptoms and pathomorphological compression factors of combined tandem stenosis, which are visualized by radiographic techniques, are not fully presented. 18,19 The course of degenerative spinal disease with a prolonged adaptation response of SMS biomechanics often predetermines surgical failure, due to decompensation of the patient's condition and circulatory disorders in the area of compressed nerve trunks or spinal cord, during surgery. The rate of unsatisfactory outcomes of surgery for degenerative spinal diseases is 28.3−53%.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of the Clinical-Instrumental Algorithm in the Treatment of Spinal Tandem Stenosis

et al. 2019

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Objective: To conduct a multicenter analysis of the effectiveness of surgical tactics for treating patients with symptomatic tandem stenosis of the cervical and lumbar spine, based on a differentiated clinical-instrumental algorithm. Methods: The study included 97 patients with symptomatic tandem stenosis of the cervical and lumbar spine. The patients were allocated into 2 groups. The main prospective follow-up group (Group I) consisted of patients (n=46) who had undergone staged decompression/stabilization surgery according to the surgical tactics developed based on the differential clinical-instrumental algorithm. The clinical comparison group (Group II) (n=51) consisted of retrospectively recruited patients who, depending on the prevailing clinical condition, underwent primary surgery at the cervical level (29 cases) or at the lumbar level (22 cases). Results: The comparative analysis in Group I revealed significantly better parameters in the clinical and instrumental data. The total rates of postoperative surgical complications in the cervical and lumbar spine were 15% in Group I and 68% in Group II (p=0.0014). Conclusion: The multicenter analysis of the clinical-instrumental algorithm based on differential application of decompression/stabilization techniques enabled more rational and radical surgery, with less adverse outcomes, leading to earlier start of rehabilitation in the prospective group of patients (Group I), and an objective improvement in long-term clinical and functional outcomes. Level of Evidence II; Prognostic Studies - Investigating the Effect of a Patient Characteristic on Disease Outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of the Clinical-Instrumental Algorithm in the Treatment of Spinal Tandem Stenosis

et al. 2019

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“…47 In addition, a significantly better correlation between dural sac cross-sectional area and clinical symptoms such as claudication distance and pain is shown for weight-bearing rather than conventional supine MRI examination. 48 Weight-bearing leads to increased lumbar lordosis (i.e., increased extension of the lumbar spine). Lumbar extension seems to aggravate spinal canal stenosis related to degenerative changes.…”

Section: Weight-bearing Mri Of the Lumbar Spinementioning

confidence: 99%

“…50,51 However, WBMRI can occasionally induce dizziness, orthostatic syncope, and aggravate pain in some patients, resulting in noncompletion of the examination. 48,[52][53][54][55][56] This risk of fainting during standing MRI may be reduced by allowing patients to walk directly into the scanner as opposed to tilting the patient from a supine to a standing position. In addition, an easily applied external pneumatic compression device positioned on the legs, or, alternatively, compression socks may reduce venous engorgement in the standing position and thereby reduce the severity of orthostatic hypotension.…”

Section: Practical and Technical Considerations For Weight-bearing Mrmentioning

confidence: 99%

Weight-bearing MRI of the Lumbar Spine: Technical Aspects

Nordberg

Hansen

Nybing

et al. 2019

Semin Musculoskelet Radiol

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Magnetic resonance imaging (MRI) has an established role in the assessment of degenerative musculoskeletal conditions. However, conventional supine MRI findings often correlate poorly with clinical findings. Some patients experience accentuated back pain in the weight-bearing position. Therefore, supine MRI may underestimate the severity of degenerative spine findings. To try and improve the clinical validity of spine imaging, axial loading devices have been used with conventional supine MR imaging to simulate loading of the upright spine. More recently, upright weight-bearing MRI systems (0.25–0.6 T) were introduced, allowing images to be obtained in the standing or seated weight-bearing position and even during upright flexion or extension, rotation, or bending. Some scanners even enable capturing of real-time spinal movement. This review addresses the technical aspects and potential challenges of weight-bearing MRI, both in clinical practice and research.

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“…This dynamic movement of the interspinous ligaments may also contribute to positional-dependent symptoms in some patients with spinal stenosis. One can appreciate how standing weight-bearing MRI with or without flexion/extension may be relevant in displaying these dynamic posterior degenerative pathologies in spinal stenosis 4,36,37 (►Fig. 8).…”

Section: Interspinous Ligamentsmentioning

confidence: 99%

Weight-bearing MRI of the Lumbar Spine: Spinal Stenosis and Spondylolisthesis

Hansen

Nordberg

Hansen

et al. 2019

Semin Musculoskelet Radiol

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Symptoms of degenerative lumbar spinal stenosis include back pain, radiculopathy, claudication, and muscular fatigue that tend to be predominant in the standing position or during walking. Lumbar spondylolisthesis is also a well-known cause of spinal stenosis, lateral recess, and neural foraminal narrowing that tends to become more severe in the upright position. This indicates a functional positional component of both spinal stenosis and spondylolisthesis. Lumbar spinal stenosis and spondylolisthesis are typically evaluated by magnetic resonance imaging (MRI) performed in the supine position with a pillow under the patient's lower limbs that slightly flexes the lumbar spine and ameliorates symptoms. Because these two entities tend to be aggravated in the upright position, it seems rational to also consider performing diagnostic imaging in these patients in the upright position. This article reviews the use of weight-bearing MRI for lumbar spinal stenosis and spondylolisthesis.

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Changes in dural sac caliber with standing MRI improve correlation with symptoms of lumbar spinal stenosis

Cited by 21 publications

References 44 publications

Efficacy of the Clinical-Instrumental Algorithm in the Treatment of Spinal Tandem Stenosis

Efficacy of the Clinical-Instrumental Algorithm in the Treatment of Spinal Tandem Stenosis

Weight-bearing MRI of the Lumbar Spine: Technical Aspects

Weight-bearing MRI of the Lumbar Spine: Spinal Stenosis and Spondylolisthesis

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