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
ARTICLE HIGHLIGHTS
Research background
Biomechanics of the individual lumbar spine structures are important since the overall spinal adaptation to compressive forces is comprised of the cumulative changes of respective elements.
Research motivation
There is a lack of works simultaneously comparing dural sac size, ligamenta flava thickness, foraminal dimensions and lumbar sagittal alignment between axial loaded and recumbent magnetic resonance imaging (MRI) in an extensive group of lower back pain patients.
Research objectives
To help the surgeons in the choice of the spinal endoscopy and spinal injections. The objective of the study was to evaluate the changes depicted by MRI of chosen lumbar spine structures upon axial-loading in comparison with recumbent MRI.
Research methods
The study covered 90 individuals assessed with three-dimensional volume isotropic acquisition MRI, first imaged in the supine position with no axial load and then again following application of an axial compressive load. Based on recumbent MRI as well as axial-loaded ones, the following were measured: the dural sac area, the ligamenta flava, the intervertebral foramina from L1-L2 to L5-S1 and the lumbosacral angle.
Research results
We found out that axial loading intensifies the narrowing of the spinal canal, thickens the ligamenta flava, narrows the intervertebral foramina from L1-L2 to L4-L5 and exaggerates lumbar lordosis.
Research conclusions
Our study reveals that there is a correlation between force compression and intensification of the lumbar spinal stenosis, intervertebral foramina narrowing, ligamenta flava thickening as well as increasing lumbar lordosis due to axial loading.
Research perspectives
There is a need to introduce computational approaches in automatic image recognition based on machine learning and deep learning to ease radiological measurements of the lumbar spine and obtain a good level of clinical prediction. Moreover, it is worth proposing axial-loading MRI as an elasticity imaging: an innovative “elastography” method designed for the lumbar spine to explore the age of the spine and the percentile grids of degenerative changes.
