Clinical Cases

Anterolisthesis: Comparison between supine and upright MRI


This case demonstrates the difference in diagnostic information yielded by performing an Upright seated examination in a 0.6Tesla MRIScanner, compared to the supine examination, performed on a conventional 1.5 Tesla scanner.

This 74 year old lady had a lamenectomy 7 years ago. She now has severe low back pain and is unable to walk without pain. The supine examination, performed on a conventional 1.5 Tesla scanner, was done 4 weeks prior to the upright scan shows a very minor anterior slip (anterolisthesis) at the L4/5 level(Red arrow)

The upright examination shows this to be more severe, where the degree of forward slip measures 7mm.(Double red arrows) It also alters in degree between flexion and extension of the spine. In addition the severe narrowing, stenosis, of the spinal canal at the level above, the L3/4 level is not evident until she bends back wards extending her spine(White arrow).These observations make a significant difference to the spine surgeon when planning his treatment.

Conventional Supine MRI

Conventional Supine MRI

 

Sitting neutral position

 

Sitting Extension

 

Sitting flexioncropped

 

 

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