Clinical Cases

Position-related lumbar spinal canal stenosis


A 64-year-old male patient suffering from pain in the lumbar region received an X-Stop implant between L4/5 18 months ago, freeing him from pain.

At present, the patient is complaining again about lumbar pain radiating to the buttocks and both upper legs. He does not experience pain when lying down; however, in a sitting or standing position, a significant increase in pain in extension and relief in flexion occurs.

The patient was scanned in an Upright™MRI, in multiple positions, such as sitting straight up, lying down, in flexion and extension.

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A – C: Sagittal images in a sitting position: flexion, neutral, extension
D: Axial image at L3-L4, disk protrusion with clearly identifiable constriction of spinal canal and impression of the dural sac
E: Axial at L4-L5, enlarged spinal canal by means of X-Stop implant
F: Sagittal image in supine position

Diagnosis:

Long segment of relatively osseous narrowing of spinal canal from L1 to S1.

Significant additional stenosis of spinal canal at L2-L3 and L3-L4 due to disc protrusions. Slight decrease of vertebral canal stenosis while in flexion or extension.

In extension clearly visible pincer-shaped spinal stenoses at L2-L3 and L3-L4. At L4-L5 post-surgical, spinal canal stenosis only barely visible. The patient’s discomfort may be explained as Claudicatio spinalis; MRI findings show a distinct position-related spinal canal stenosis.

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