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The patient is a 30 year-old female previously diagnosed with spondylolithesis at L5-S 1 with spina biffida occulta.  For approximately one year the patient has been suffering increasingly from pain in particular at rotation, flexion  and hyperextension.A trauma is not present. Pain extending predominantly in the lateral thigh and right lower leg and to a lesser extent also in the lateral left thigh.A segment instability was assumed which could neither be substantiated nor disproved in the recumbent MRI. The patient was subsequently examined in the Uprigh™MRI, lying down as well as sitting upright, in hyperextension and in flexion.

Functional Imaging in the natural weight-bearing state
Sagittal images, sitting: flexion, neutral, hyperextension, lying down.
By means of functional imaging in a natural weight-bearing state, a segment instability could be definitely ruled out.

The diagnosis:

Clear anterolisthesis from L5 as a result of a deformity and severe degenerative changes to the vertebral joints at the same height.

The absence of a change in position while recumbent, sitting as well as in flexion and hyperextension contradicts the existence of a segment instability.

In hyperextension, compared to the flexion position, there is a visible increase in the foraminal stenosis on the right at L5-S1, so that an intermittent irritation of the L5 nerve root is a possibility.

Parasagittal images, sitting: hyperextension, flexion.
This case history was kindly placed at our disposal by Prof. Dr. med. Hans-Konrad Beyer of the Private Practice for Upright™ Magnetic Resonance Imaging Cologne/Germany. You can reach the site at www.mrt-koeln.de