Clinical Cases

Severe, functional spinal canal stenosis in the lumbar spine region with natural weight-bearing in the standing and seated positions.

The 60 year-old patient presented here is suffering from chronic, recurrent lumbar syndrome, which has become progressively worse over the last 2 years. This is accompanied by pseudoradical lumbar ischialgia radiating to both legs, depending on load and posture, and limited walking ability.

An earlier examination in the supine position did not con rm diagnosis. Upright MRI con rmed dynamic spinal canal stenosis. Upright MRI was carried out with natural weight-bearing in an upright neutral seated position with seated flexion and standing extension. The  findings were compared with external conventional MRI scans taken in the supine position  five months earlier.

Lumbar Spine

The examination carried out five months earlier in the supine position, and used as a comparison, did not provide any obvious explanation for the patient’s symptoms. Only the Upright MRI scan clarified the position and weight dependent symptoms: Absolute, function dependent spinal canal stenosis with pincer shaped narrowing of the Cauda equina visible in segment L 4/5 in the standing extension posture.

Evidence in segment L3/4 of function-dependent, relative spinal canal stenosis with narrowing of the Caudia equina in the standing extension posture and function-dependent pseudospondylolisthesis with functional anterolisthesis of L3 (ventral displacement of 3-4 mm / grade 1 according to Meyerding) with unremarkable dorsal alignment in the supine and seated positions. The neural foramina in segments L3 to S1 are significantly narrowed on both sides in a natural weight- bearing position but especially in the standing extension position.

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