Clinical Cases

Spinal Fusion: Comparison between supine and upright MRI

Female patient with lumbar syndrome following extensive spinal fusion.

The case presented here refers to a 61 year-old female patient with persistent, post-operative lumbar syndrome following extensive spinal fusion from lumbar vertebra 2 to lumbar vertebra 5 with additional cage implantations and recurrent, clearly load- and position-dependent lumbar ischialgia with right-sided radiation particularly when seated and standing, and relatively no symptoms in the supine position.

A post-operative MRI scan in the supine position in a 1.5 Tesla tunnel system could not be assessed diagnostically because of extensive metal artefacts.

Therefore, a targeted Upright MRI scan was performed, focusing on load- and position-dependent symptoms and as a result of substantially reduced metal artefact formation.

The diagnosis:

The dynamic positional Upright MRI scan carried out highlighted the cause of the symptoms and revealed atypical medial positioning / DD (differential diagnosis) incorrect positioning

of the right pedicle screw at lumbar vertebra segment 3 with potential irritation of the right nerve root L3. Otherwise, correct positioning of the implanted material in a patient with marked lumbar scoliosis.

Evidence in lumbar vertebra 4/5 of paramedian intervertebral disc prolapse with accentuated adjacent involvement as far as the right nerve root L4 and subsequent risk of irritation with natural weight-bearing in seated and standing positions.

Subsequent degeneration in lumbar vertebra segment 1/2 with onset of posterior instability with apparent structural breakdown on the posterior border of the spinal canal on extension in the standing position and consecutively relative function-dependent spinal canal stenosis.

A clear diagnosis could be made to clarify the patient’s symptoms through extremely low metal artefact sensitivity and function images in a natural weight-bearing position.

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