Archive of Upright Multi-Position MRI Cases
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Case#: 13       Alteration of Surgical Treatment as a Result of Upright Multi-Position MRI
         
Alteration of Surgical Treatment as a Result of Upright Multi-Position MRI
The recumbent scan on this patient with chronic low back pain shows a mild L4/5 disc prolapse that was not considered severe enough to warrant surgery. Little change occurred in the Standing position. However, a spondylolisthesis at L4/5 becomes evident in the seated neutral position in addition to a circumferential prolapse of the L5/S1 disc. Flexion and Extension changes the appearance of the discs indicating significant instability at both levels. There is some loss of disc height at L5/S1 in the UPRIGHT® standing position relative to the recumbent position but the most pronounced diminishing of disc height is visualized at L5/S1 in the UPRIGHT® seated positions neutral sit, flexion and extension. The loss in disc height is accompanied by an anteriolisthesis of L5. In addition in the seated position a significant reduction in disc height occurs at L4/5 that is accompanied by an anteriolisthesis of L4 that becomes especially pronounced in the UPRIGHT® seated extension position. Without the seated images, the surgical plan was an L4/5 nerve root decompression. The complete dynamic study altered the surgeon´s management of this patient to include a 3-level Dynesis ligament stabilization in addition to decompressive surgery.

 

Case Courtesy of F.W.Smith, MD, University of Aberdeen, Scotland, United Kingdom
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