Hebelka Hanna, Rydberg Niklas, Hutchins John, Lagerstrand Kerstin, Brisby Helena
Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE413 45 Gothenburg, Sweden.
Department of Radiology, Sahlgrenska University Hospital, SE413 45 Gothenburg, Sweden.
J Clin Med. 2022 Apr 11;11(8):2122. doi: 10.3390/jcm11082122.
Lumbar foraminal stenosis is a common cause of lumbar radiculopathy and conventionally assessed with magnetic resonance imaging (MRI) in supine-positioned patients. An MRI acquired during spine loading may unmask pathology not otherwise revealed in a relaxed position. Therefore, we investigated how spine loading during MRI affects lumbar foramina. In 89 low-back pain patients' lumbar, MRIs were performed in a relaxed supine position and during axial loading using a Dynawell compression device. The smallest area of all intervertebral foramina at levels L3/L4-L5/S1 (534 foramina) was determined using a freehand polygonal tool in parasagittal T2-weighted sequences. The grading system described by Lee et al. was also used to qualitatively assess foraminal stenosis. Overall, a mean reduction of 2.2% (mean -0.89 cm and -0.87 cm, respectively) was observed ( = 0.002), however for individual foramina large variations, with up to about 50% increase or decrease, were seen. Stratified for lumbar level, an area reduction was found for L3/L4 and L4/L5 foramina (mean change -0.03 cm; = 0.036; and -0.03 cm; = 0.004, respectively) but not for L5/S1. When comparing the measured area changes to qualitative foraminal grading, 22% of the foramina with a measured area decrease were evaluated with a higher grading. Thus, detailed information on foraminal appearance and nerve root affection can be obtained using this method.
腰椎管狭窄症是腰椎神经根病的常见病因,传统上通过对仰卧位患者进行磁共振成像(MRI)来评估。在脊柱负荷状态下进行的MRI检查可能会发现患者放松体位时未显示出的病变。因此,我们研究了MRI检查期间脊柱负荷对腰椎椎间孔的影响。对89例腰痛患者的腰椎进行了MRI检查,分别在放松仰卧位以及使用Dynawell加压装置进行轴向负荷时进行扫描。在矢状面T2加权序列中,使用徒手多边形工具确定L3/L4至L5/S1节段所有椎间孔的最小面积(共534个椎间孔)。还采用Lee等人描述的分级系统对椎间孔狭窄进行定性评估。总体而言,观察到平均减少了2.2%(分别平均减少 -0.89 cm和 -0.87 cm)(P = 0.002),然而,对于单个椎间孔,观察到有高达约50%的增减变化。按腰椎节段分层分析,发现L3/L4和L4/L5椎间孔面积减小(平均变化分别为 -0.03 cm;P = 0.036和 -0.03 cm;P = 0.004),而L5/S1椎间孔面积未减小。将测量的面积变化与椎间孔定性分级进行比较时,在测量面积减小的椎间孔中,有22%的椎间孔在定性分级中被评估为更高等级。因此,使用该方法可以获得有关椎间孔外观和神经根受累情况的详细信息。