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Vertical simulator in MRI lumbar investigations 2008

General Spine

Jacques G Theron, MD,

Scientific Paper

Purpose

The human upright standing position is partly responsible for the pathological phenomena that occur in the lumbar spine. It induces changes in spinal components which cannot always be demonstrated on regular supine MRI.
We have designed a simple device that simulates the vertical position

Methods & Materials

The device consists of a non ferromagnetic board with dynamometer and graduated tapes. We currently use the device in cases where we need more information to localize precisely where the intraspinal conflict is and of what it consists.
More recently was added a balloon that induces lordosis in order to enhance the vertical simulation effect.

Results

A comparative study of twenty cases presenting a narrow lumbar canal has shown that in no case did the MRI with vertical simulation show less information than the standing myelogram.
In disk pathology an enhancement of the disk bulging is regularly observed along with a localized increase of the canal narrowness and/or facet joints opening. This complementary information allows a better selection of the disk to be treated, preferentially percutaneously, when several disk bulgings are observed.
In spondylolithesis cases thorough understanding of the anatomical conflict is particularly informative. In patients with scolioses the exact site of the conflict induced by the lateral flexion of the spine in the standing position is well demonstrated (fig 1,2). In post surgical cases unexpected type and site of conflict can be demonstrated (fig 3,4).

Conclusion

This device represents a simple and cheap new tool providing competitive information with standing MRI units.

References

Jacques Theron, consultant Medicor

Images

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