Study Design

Retrospective chart review.

Purpose

To assess whether spontaneous reduction of spondylolisthesis, as seen on magnetic resonance imaging (MRI), is related to the degree of segmental instability and low back pain.

Overview of Literature

The flexion-extension radiographs obtained in the sagittal plane are frequently used when segmental instability of spondylolisthesis is evaluated.

Methods

We retrospectively reviewed 137 patients and measured the differences of the percentage of sagittal translation and sagittal angulation to determine the segmental instability between the flexion and extension radiographs, and the spontaneous reduction on MRI. We then compared the degrees of segmental instability and the degrees of spontaneous reduction. To assess the effect of low back pain on segmental motion in regards to the flexion-extension radiographs, we compared the preoperative visual analogue scales (VAS) score for low back pain between the more and the less spontaneous reduction groups.

Results

The mean degree of spontaneous reduction was 5.2%. A statistically significant correlation was found between the sagittal translation on the flexion-extension radiographs and the degree of spontaneous reduction (r = 0.557, p < 0.001) and between the sagittal angulation on the flexion-extension radiographs and the degree of spontaneous reduction (r = 0.215, p = 0.012). The preoperative VAS scores for low back pain of the more spontaneous reduction group and the less spontaneous reduction group were 4.6 and 3.6 points, respectively, and this difference was statistically significant (p = 0.002).

Conclusions

Spontaneous reduction of spondylolisthesis on MRI was found to be closely related to segmental instability, and the degree of spontaneous reduction seen on MRI could be useful for the evaluation of segmental instability in patients with spondylolisthesis, especially with severe low back pain.

Study Design

Retrospective study MR images for spinal cord tumors.

Purpose

To analyze the characteristics of MR images for spinal cord tumors, which were then verified at surgery or biopsy.

Overview of Literature

MR images are often used as the primary diagnostic imaging tool and the preoperative study of choice. The need for biopsy may be obviated because of increasingly accurate preoperative histologic diagnosis by MR images.

Methods

The study group consisted of 39 patients who had undergone MR imaging for preoperative evaluation of spinal cord tumors between September 1989 and February 2008. All patients had operations for spinal cord tumors, which were confirmed at biopsy. Of the 39 patients, 18 were men, and 21 were women. The average follow-up period was 23.8 months. The mean patient age was 46.6 years.

Results

Diagnoses included neurilemmoma (19 cases), neurofibroma (4 cases), meningioma (5 cases), hemangioma (3 cases), giant cell tumor (1 case), ganglioneuroma (1 case), lymphoma (1 case), neuroblastoma (1 case), and metastatic tumor from the prostate (1 case). The remaining 3 cases were composed of arachnoid cysts (2 cases) and a vascular malformation (arteriovenous malformation, 1 case).

Conclusions

MR images are the preoperative modality of choice in the evaluation of spinal cord tumors. MR images can narrow the differential diagnosis and guide surgical resection.

Study Design

This is a retrospective study.

Purpose

We wanted to investigate the clinical relevance of the lumbar high intensity zone (HIZ) on magnetic resonance imaging (MRI) and the relationship of trauma history to internal disc disruption (IDD).

Overview of Literature

HIZs on lumbar spine (L-spine) MRI have been suggested as a reliable marker of IDD by some authors. The prevalence and type of spinal trauma in IDD have not yet been carefully analyzed.

Methods

L-spine MRIs of 737 patients with low back pain with or without associated leg pain were reviewed for the presence of HIZs. HIZs on T2-weighted MR images were determined according to the Aprill and Bogduk criteria. A review of medical records and a telephone interview were performed for further analyses of pain.

Results

HIZs were found in 117 patients and 153 discs among a total of 737 patients who met the inclusion criteria. Both a medical record review and a telephone interview were possible with 99 patients. Among these, 42 patients had had an episode of trauma. Seventeen of these had a relatively high-energy injury such as a traffic accident or a fall. Regarding back pain, 27 patients complained of typical discogenic back pain. Only 11 patients had both a trauma history and typical discogenic pain and 41 patients (42%) had neither a trauma history nor typical natural pain.

Conclusions

Given the low incidence of discogenic pain, a HIZ on an L-spine MRI appears less meaningful than often assumed as a specific marker of IDD. Trauma, such as a traffic accident, seems unlikely to be the main cause of IDD.