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The potential value of MR imaging in the seated position: A study of 116 patients suffering from low back pain and sciatica

Francis W. Smith, M.D., Malcolm Pope, Ph.D.

Purpose
The clinical symptoms of the lumbar spinal stenosis are often posture related. The availability of Open “Stand-Up” MRI enables images of the spine to be made in any posture. This study explores the potential of upright MRI scanning in neutral, flexion and extension in sitting and supine position of patients with low back symptoms.

Materials & Method
116 patients (45 female - 71 male) (Age 35 - 71 years, mean 44 years), suffering from low back pain and/or sciatica were studied. Each examination was performed using a 0.6 Tesla Open “Stand-Up” MRI. (FONAR, Melville, NY) MR Images were obtained in both the supine, seated neutral, seated flexed and extended positions.

Results
Measurements from “Normal discs” show changes of only 1mm in disc height between supine and sitting, increasing to 2 - 4mm reduction in height anteriorly in forward flexion and between 2 - 4mm reduction in height posteriorly on extension Measurements from “Degenerate discs” show 1 - 3mm change in disc height between supine and sitting and significant reduction in disc height and position on flexion and extension. 108 prolapsed discs showed reduction of posterior prolapse on forward flexion & increase in extension, whilst 23 showed a decrease in posterior prolapse on extension. In 21 cases, the presence of a Grade 1 spondylolisthesis, not evident in the supine examination, was demonstrated in the seated position. In all cases, a degree of instability was demonstrated in the flexion and extension views.

In 4 cases of sciatica experienced whilst seated, in which the supine examination showed no abnormality, transforaminal disc herniation was demonstrated in the seated position.

21/116 = 18%

Conclusion
We believe that the ability to image in the seated position is a major advance in the examination of the lumbar spine, especially in those patients with spondylolisthesis and position dependent disc prolapse.

European Society of Skeletal Radiology (ESSR) 2004
June 18-19, 2004 Augsburg, Germany

Source: http://www.essr.org/Augsburg2004/ScientificProgramAbstracts28May04.pdf

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