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Functional MRI of the postoperative spine
J.P. Elsig, M.D., D.L. Kaech, M.D., J.R. Jinkins, M.D.
Introduction and purposes
Imaging of the spine is now possible utilizing an open MRI unit, allowing studies under physiologic loading and during kinetic maneuvers. Our purpose is to present an overview of first results in the postoperative spine obtained at the new fmri imaging center in Zurich utilizing FMRI (functional magnetic resonance imaging).
Material and methods
Patients with a history of recurrent positional or motion dependent pain and neurological dysfunction following surgery of the cervical and lumbar spine were investigated in the upright seated or standing position, including flexion-extension imaging.
Results
A position dependent appearance or increase of disc protrusions/herniations, and varying degrees of instability (hypermobile spondylolisthesis), could be demonstrated in cases with preceding relatively unremarkable recumbent imaging. Illustrative cases include motion-dependent recurrent disc herniations and dynamic stenosis of the central spinal canal and neural foramina in the cervical and lumbar spine adjacent to a rigid single or multilevel spinal fusion.
Discussion and conclusions
The differential diagnosis of failed back surgery syndrome includes the so-called adjacent segment disease, The potential of FMRI to detect dynamic stenosis not visible on recumbent imaging enabled a more focused therapeutic planning approach to be undertaken in patients with recurrent pain and neurologic dysfunction following spine surgery (provided they have no ferromagnetic spinal implants). Initial experience with this technology indicates that one of a major indication for FMRI is the failed back surgery syndrome.
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| The upright-flexion image above shows advanced spondylosis and postoperative intersegmental bony fusion of C5 through C7. Note the angular hypermobility at the level suprajacent to the fused levels at C4/5 after laminectomy of C4. |
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The midline upright-extension image above reveals a posterior disc herniation suprajacent to the fused levels (C4/5), and associated indentation of the anterior surface of the spinal cord.
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| The right paramedian image above shows the larger component of the disc herniation extending to the right of midline and associated impingement on the right lateral surface of the spinal cord anterioraly and posterioraly from the the tip of the lamina C5.
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References
1. Jinkins JR, Dworkin JS, Damadian RV. Upright, Weight-Bearing, Dynamic-Kinetic MRI of the Spine: Initial Results. In Press, European Radiology, 2005.
2. Jinkins JR. Positional-Kinetic MRI of the Spine: p/k MRI. The Evolving Future Responsibility of the Medical Imaging Specialist in Diagnostic Imaging of the Pre- and Postoperative Spine. Rachis 15: 4/5, 242-243, 2003.
3. Jinkins JR, Dworkin JS, Green CA, Greenhalgh JF, Gianni M, Gelbein M, Wolf R, Damadian J, Damadian RV. Upright, Weight-Bearing, Dynamic-Kinetic MRI of the spine: pMRI/kMRI – Overview of first results obtained with the Stand-Up™ MRI System. Argos Spine News 8: 16-21, 2003.
4. Jinkins JR, Dworkin J. Upright, Weight-Bearing, Dynamic-Kinetic MRI of the Spine: pMRI/kMRI. In: Spinal Restabilization Procedures: Diagnostic and Therapeutic Aspects of Intervertebral Fusion Cages, Artificial Discs and Mobile Implants. Kaech DL, Jinkins JR (Eds.). Amsterdam, Elsevier. pp 73-82, 2002.
5. Jinkins JR, Dworkin JS, Green CA, Greenhalgh JF, Gianni M, Gelbein M, Wolf R, Damadian J, Damadian RV. Upright, Weight-Bearing, Dynamic-Kinetic MRI of the Spine: pMRI/kMRI. Riv di Neuroradiol 15: 333-356, 2002.
6. Kaech DL: Dilemmas in the treatment of adjacent segment disease. Poster Presentation. ARGOS International Symposium, Paris, January 29-30, 2004.
5th Congress of the Slovak Spine Society (SSS) 2005
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Group studies