Effects of axial loading and positions on lumbar spinal stenosis: an MRI study using a new axial loading device.

IF 1.9 3区医学 Q2 ORTHOPEDICS Skeletal Radiology Pub Date : 2025-02-01 Epub Date: 2024-06-07 DOI:10.1007/s00256-024-04720-5

Xingyu Fang, Mengqiu Cui, Yingwei Wang, Lin Liu, Wei Lv, Huiyi Ye, Gang Liu

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Abstract

Objective: A new axial loading device was used to investigate the effects of axial loading and positions on lumbar structure and lumbar spinal stenosis.

Methods: A total of 40 patients sequentially underwent 4 examinations: (1) the psoas-relaxed position MRI, (2) the extended position MRI, (3) the psoas-relaxed position axial loading MRI, (4) the extended position axial loading MRI. The dural sac cross-sectional area, sagittal vertebral canal diameter, disc height and ligamentum flavum thickness of L3-4, L4-5, L5-S1 and lumbar lordosis angle were measured and compared. A new device with pneumatic shoulder-hip compression mode was used for axial loading.

Results: In the absence of axial loading, there was a significant reduction in dural sac cross-sectional area with extension only seen at the L3-4 (p = 0.033) relative to the dural sac area in the psoas-relaxed position. However, with axial loading, there was a significant reduction in dural sac cross-sectional area at all levels in both psoas-relaxed (L3-4, p = 0.041; L5-S1, p = 0.005; L4-5, p = 0.002) and extension (p < 0.001) positions. The sagittal vertebral canal diameter and disc height were significantly reduced at all lumbar levels with axial loading and extension (p < 0.001); however, in psoas-relaxed position, the sagittal vertebral canal diameter was only reduced with axial loading at L3-4 (p = 0.018) and L4-5 (p = 0.011), and the disc height was reduced with axial-loading at all levels (L3-4, p = 0.027; L5-S1, p = 0.001; L4-5, p < 0.001). The ligamentum flavum thickness and lumbar lordosis in extension position had a statistically significant increase compared to psoas-relaxed position with or without axial loading (p < 0.001).

Conclusion: Both axial loading and extension of lumbar may exacerbate lumbar spinal stenosis. Axial loading in extension position could maximally aggravate lumbar spinal stenosis, but may cause some patients intolerable. For those patients, axial loading MRI in psoas-relaxed position may be a good choice.

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轴向加载和体位对腰椎管狭窄症的影响：使用新型轴向加载装置进行的磁共振成像研究。

目的采用新型轴向加载装置研究轴向加载和体位对腰椎结构和腰椎管狭窄症的影响：共有 40 名患者依次接受了 4 次检查：(1) 腰肌放松位核磁共振成像；(2) 腰肌伸展位核磁共振成像；(3) 腰肌放松位轴向加载核磁共振成像；(4) 腰肌伸展位轴向加载核磁共振成像。测量并比较了 L3-4、L4-5、L5-S1 的硬膜囊横截面积、矢状椎管直径、椎间盘高度和黄韧带厚度以及腰椎前凸角度。结果显示：在没有轴向负荷的情况下，腰椎间盘的高度和黄韧带的厚度均有所增加：结果：在无轴向负荷的情况下，与腰肌放松位置的硬膜囊面积相比，仅 L3-4 硬膜囊的横截面积随着伸展而显著缩小（p = 0.033）。然而，在轴向负荷下，腰肌松弛位置（L3-4，p = 0.041；L5-S1，p = 0.005；L4-5，p = 0.002）和伸展位置（p < 0.001）的硬膜囊横截面积在所有级别都有显著减少。所有腰椎级别的椎管矢状面直径和椎间盘高度在轴向加载和伸展时均显著降低（p < 0.001）；然而，在腰肌放松体位下，椎管矢状面直径仅在L3-4（p = 0.018) 和 L4-5 (p = 0.011)，椎间盘高度在所有水平上都随着轴向负荷而降低（L3-4，p = 0.027；L5-S1，p = 0.001；L4-5，p < 0.001）。黄韧带厚度和腰椎前凸在伸展位置与腰肌放松位置相比，无论有无轴向负荷，均有统计学意义上的显著增加（p < 0.001）：结论：腰椎的轴向负荷和伸展都可能加重腰椎管狭窄。结论：轴向加载和腰椎伸展都可能加重腰椎管狭窄。伸展位的轴向加载可最大程度地加重腰椎管狭窄，但可能导致部分患者无法忍受。对于这些患者，腰肌放松位的轴向负荷 MRI 可能是一个不错的选择。

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来源期刊

Skeletal Radiology 医学-核医学

CiteScore

4.40

自引率

9.50%

发文量

253

审稿时长

3-8 weeks

期刊介绍： Skeletal Radiology provides a forum for the dissemination of current knowledge and information dealing with disorders of the musculoskeletal system including the spine. While emphasizing the radiological aspects of the many varied skeletal abnormalities, the journal also adopts an interdisciplinary approach, reflecting the membership of the International Skeletal Society. Thus, the anatomical, pathological, physiological, clinical, metabolic and epidemiological aspects of the many entities affecting the skeleton receive appropriate consideration. This is the Journal of the International Skeletal Society and the Official Journal of the Society of Skeletal Radiology and the Australasian Musculoskelelal Imaging Group.