Authors: P. Kolář 1; J. Štulík 2; M. Kynčl 3 Authors place of work: FN v Motole, Praha Klinika rehabilitace a tělovýchovného lékařství 2. LF UK v Praze 1; FN v Motole, Praha Oddělení spondylochirurgie 2; FN v Motole, Praha Klinika zobrazovacích metod 2. LF UK v Praze 3 Published in the journal: Cesk Slov Neurol N 2010; 73/106(4): 438-442 Category: Kazuistika
Patients with vertebrogenic problems are usually examined by magnetic resonance imaging (MRI) in the stationary, relaxed supine position only. This position, however, does not allow sufficient evaluation of morphological findings since these may vary under different postural, spine-loading situations. This has been confirmed by MRI assessment with the patient standing or by dynamic MRI assessment with the patient bending forwards or backwards. At this time, there is no MRI device in the Czech Republic that permits assessment with the patient standing or bending, so we perform MRI assessment while inducing stabilizing muscle activity. For lumbar spine evaluation, MRI analysis at the same time as hip flexion against some small resistance or just gravity proves to be spine-loading and therefore dynamic, since the patient needs to activate not only hip flexors, but also spinal stabilizers. Such an MRI assessment allows for intradiscal movement, shape measurement, and a degree of stability, allowing regional anatomical parameter measurements and analysis of disc/nerve root relationships during dynamic postural loading. Disturbed function of soft tissue structures in response to various postural situations may result in discrepancies between subjective symptoms, neurological signs, and morphological findings arising out of the static supine position. Stability analysis by means of dynamic MRI studies may also assist in determining the optimum surgical procedure for any given patient.
Key words: vertebrogenic syndromes – postural function – dynamic magnetic resonance imaging
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