European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Magnetic resonance imaging (MRI) is the established technique for evaluating the spine. Unfortunately, the supine position of the patient during conventional MRI scanning does not truly reflect the physiological forces experienced by the discoligamentous structures during normal upright posture and ambulation. Upright MRI is a relatively new technique that allows the patient to be scanned in several different weight-bearing positions, which may potentially demonstrate occult pathology not visualised in the supine position. The imaging technique and current clinical indications of upright spinal MRI would be discussed.
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The accurate diagnosis of spondylolysis is widely made with CT scan considered as the gold standard. However, CT represents significant radiation exposure particularly substantial in a young and sometimes still growing population. Although the role of MRI in identifying edema/inflammation within the pars as an active lesion is proved, its ability to demonstrate and classify pars fracture line as same as CT is still controversial. This meta-analysis aimed to determine sensitivity and specificity of MRI in the direct visualisation of the pars defect. ⋯ This meta-analysis demonstrated a high diagnostic performance of MR imaging for the diagnosis of a pars defect in young adults. This technique may be considered as a first-line imaging technique as it helps to avoid exposure to ionising radiation.
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To review the current literature on methods of accurate numeration of vertebral segments in patients with Lumbosacral transitional vertebrae (LSTVs). LSTVs are a common congenital anomaly of the L5-S1 junction. While their clinical significance has been debated, unquestionable is the need for their identification prior to spinal surgery. We hypothesize that there are no reliable landmarks by which we can accurately number transitional vertebrae, and thus a full spinal radiograph is required. ⋯ A sagittal whole spine view should be added as a scout view when patients obtain lumbar MRI to standardize the vertebral numbering technique. To date, there has been no other method for accurate numeration of a transitional vertebral segment, other than counting caudally from C2. These slides can be retrieved under Electronic Supplementary Material.