The Pain Clinic, University Hospital Sanitas La Moraleja, Madrid, Spain.
The Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA; The Alon P. Winnie Research Institute, Still Bay, Western Province, South Africa; The Lumina Pain Medicine Collaborative, Surrey, United Kingdom.
Pain Physician. 2022 Aug;25(5):409-418.
There are patients with limiting low back pain (LBP) with or without radicular pain in whom conventional supine magnetic resonance imaging (MRI) show no causative pathology. Despite the limitations of dynamic axially loaded MRI examinations, these imaging studies have shown a striking ability to diagnose pathology unrecognized by conventional MRI. The difference in findings between supine and prone MRI with patient symptom correlation has not been studied.
Nineteen patients suffering from chronic moderate-to-severe LBP and/or radicular pain nonresponsive to conventional therapy or interventional treatment, were included in this study. Both supine and prone MRIs were performed and analyzed by a neuroradiologist. Specific supine and prone measurements were registered, including spinal canal area, lateral recess diameter, foraminal area, and ligamentum flavum thickness. Three-dimensional MRI reconstructions of varying pathology patterns were created.
The mean patient age was 48.7 years (range [R]: 30-69), 63% of patients were women. The mean numeric pain score was 6.5 (R: 4-8). In 52.6% of cases, disc pathology/increased disc pathology was seen only on prone imaging. We observed significant buckling and increased thickness of the ligamentum flavum in 52.6 % of cases in the prone position that was absent from the supine MRIs. We also documented varying grades of spondylolisthesis and facet joint subluxation resulting in significant foraminal stenosis in 26.3% of prone cases not seen from supine MRIs.
Four patterns of pathological findings have been identified by MRI performed in the prone position. These findings were not observed in the supine position. Prone MRI can be a significant and useful tool in the diagnosis and treatment of patients with back pain refractory to treatment whose conventional supine MRIs appeared unremarkable.
有些患者患有局限性腰痛（LBP），伴有或不伴有神经根痛，常规仰卧位磁共振成像（MRI）未显示病因病理学。尽管轴向加载动态 MRI 检查存在局限性，但这些影像学研究显示出诊断常规 MRI 未识别的病理学的惊人能力。尚未研究仰卧位和俯卧位 MRI 之间的检查结果差异与患者症状的相关性。
本研究纳入了 19 例患有慢性中重度腰痛（LBP）和/或神经根痛的患者，这些疼痛对常规治疗或介入治疗无反应。由神经放射科医生对患者进行仰卧位和俯卧位 MRI 检查和分析。记录了特定的仰卧位和俯卧位测量值，包括椎管面积、侧隐窝直径、椎间孔面积和黄韧带厚度。创建了不同病理模式的三维 MRI 重建。
患者平均年龄为 48.7 岁（范围[R]：30-69），63%为女性。平均数字疼痛评分（numeric pain score）为 6.5（R：4-8）。52.6%的病例仅在俯卧位影像学上观察到椎间盘病变/椎间盘病变增加。我们观察到 52.6%的病例中黄韧带在俯卧位时明显弯曲和增厚，而仰卧位 MRI 上未见这种情况。我们还记录了不同程度的脊椎滑脱和小关节半脱位，导致 26.3%的俯卧位病例出现明显的椎间孔狭窄，而仰卧位 MRI 上未见这种情况。
通过俯卧位 MRI 发现了 4 种病理表现模式。这些发现未在仰卧位 MRI 上观察到。俯卧位 MRI 可以成为诊断和治疗治疗后腰痛的有效工具，这些患者的常规仰卧位 MRI 未见明显异常。
