Lorenc T, Gołębiowski M, Michalski W, Glinkowski W. High-resolution, three-dimensional magnetic resonance imaging axial load dynamic study improves diagnostics of the lumbar spine in clinical practice. World J Orthop 2022; 13(1): 87-101 [PMID: 35096539 DOI: 10.5312/wjo.v13.i1.87]
Corresponding Author of This Article
Tomasz Lorenc, MD, PhD, Associate Professor, Ist Department of Clinical Radiology, Medical University of Warsaw, 5 Chalubinskiego Street, Warsaw 02-004, Poland. tlorenc@wum.edu.pl
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jan 18, 2022; 13(1): 87-101 Published online Jan 18, 2022. doi: 10.5312/wjo.v13.i1.87
High-resolution, three-dimensional magnetic resonance imaging axial load dynamic study improves diagnostics of the lumbar spine in clinical practice
Tomasz Lorenc, Marek Gołębiowski, Wojciech Michalski, Wojciech Glinkowski
Tomasz Lorenc, Marek Gołębiowski, Ist Department of Clinical Radiology, Medical University of Warsaw, Warsaw 02-004, Poland
Wojciech Michalski, Department of Mathematical Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw 02-781, Poland
Wojciech Glinkowski, Center of Excellence “TeleOrto” for Telediagnostics and Treatment of Disorders and Injuries of the Locomotor System, Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw 00-581, Poland
Author contributions: Lorenc T, Gołębiowski M and Michalski W designed the research and collected the data; Lorenc T and Michalski W analyzed the data; Lorenc T and Gołębiowski M wrote the paper; Lorenc T and Glinkowski W contributed to manuscript revision; all authors approved the final version of the manuscript.
Institutional review board statement: The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Bioethical Review Board at Medical University of Warsaw (AKBE/100/13—obtained on December 10, 2013).
Informed consent statement: Informed consent was obtained from all subjects involved in the study.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Data sharing statement: The dataset analyzed are not publicly available but are available from the corresponding author upon reasonable request.
STROBE statement: The guidelines of the STROBE Statement-checklist of items have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tomasz Lorenc, MD, PhD, Associate Professor, Ist Department of Clinical Radiology, Medical University of Warsaw, 5 Chalubinskiego Street, Warsaw 02-004, Poland. tlorenc@wum.edu.pl
Received: June 14, 2021 Peer-review started: June 14, 2021 First decision: October 18, 2021 Revised: November 2, 2021 Accepted: January 5, 2022 Article in press: January 5, 2021 Published online: January 18, 2022
Abstract
BACKGROUND
The response to axial physiological pressure due to load transfer to the lumbar spine structures is among the various back pain mechanisms. Understanding the spine adaptation to cumulative compressive forces can influence the choice of personalized treatment strategies.
AIM
To analyze the impact of axial load on the spinal canal’s size, intervertebral foramina, ligamenta flava and lumbosacral alignment.
METHODS
We assessed 90 patients using three-dimensional isotropic magnetic resonance imaging acquisition in a supine position with or without applying an axial compression load. Anatomical structures were measured in the lumbosacral region from L1 to S1 in lying and axially-loaded magnetic resonance images. A paired t test at α = 0.05 was used to calculate the observed differences.
RESULTS
After axial loading, the dural sac area decreased significantly, by 5.2% on average (4.1%, 6.2%, P < 0.001). The intervertebral foramina decreased by 3.4% (2.7%, 4.1%, P < 0.001), except for L5-S1. Ligamenta flava increased by 3.8% (2.5%, 5.2%, P < 0.001), and the lumbosacral angle increased.
CONCLUSION
Axial load exacerbates the narrowing of the spinal canal and intervertebral foramina from L1-L2 to L4-L5. Cumulative compressive forces thicken ligamenta flava and exaggerate lumbar lordosis.
Core Tip: In this study, a statistically proven correlation was made between the axial loading and lumbar spinal stenosis, thickening of the ligamenta flava, narrowing of the intervertebral foramina from L1-L2 to L4-L5 and lumbar lordosis exaggeration. A novel aspect of this study was a simultaneous comparison of the dural sac size, ligamenta flava thickness, foraminal dimensions and lumbar sagittal alignment between axial loaded and recumbent three-dimensional high-resolution magnetic resonance imaging in an extensive group of lower back pain patients. This was done to conduct a detailed evaluation for better spinal surgery decision-making and spinal injections.
