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Changes in lumbar spondylolisthesis on axial-loaded MRI: do they reproduce the positional changes in the degree of olisthesis observed on X-ray images in the standing position?

BACKGROUND CONTEXT: Axial-loaded magnetic resonance imaging (MRI) can partially simulate the lumbar spine in patients in a standing position and potentially provides additional imaging findings that cannot be obtained with conventional MRI in the clinical assessment of patients with degenerative lumbar disease. Previous studies have shown that axial-loaded MRI demonstrates a significant reduction in the size of the dural sac compared with conventional MRI. However, there has been no study to compare the degree of olisthesis among conventional MRI, axial-loaded MRI, and upright X-ray imaging in patients with degenerative spondylolisthesis (DS).

PURPOSE: The purpose of the study is to determine whether axial-loaded MRI can demonstrate similar positional changes in lumbar olisthesis as those detected on upright lateral X-ray in patients with DS.

STUDY DESIGN: This is an imaging cohort study.

PATIENT SAMPLE: A total of 43 consecutive patients with DS exhibiting olisthesis of 3 mm or more on X-ray images in the standing position were prospectively evaluated in this study.

OUTCOME MEASURES: The degree of olisthesis, intraclass correlation coefficient (ICC), and percentage of patients exhibiting olisthesis of 3 mm or more on MRI.

METHODS: The degree of olisthesis was measured on conventional MRI, axial-loaded MRI, and lateral X-ray imaging performed in the upright position. The degree of olisthesis was compared among the three imaging techniques. The ICC values for the measurements of olisthesis between X-ray studies and conventional and axial-loaded MRI were calculated and compared. The percentage of patients exhibiting olisthesis of 3 mm or more was compared between conventional MRI and axial-loaded MRI.

RESULTS: The degree of olisthesis on axial-loaded MRI (5.9±2.5 mm) was significantly greater than that observed on conventional MRI (4.4±2.4 mm) (p<.05) although the degrees on conventional and axial-loaded MRI were significantly smaller than that on upright X-ray images (7.1±2.8 mm) (p<.05). The ICC between axial-loaded MRI and X-ray imaging (0.75, 95% confidence interval: 0.58-0.85) was considerably greater than that observed between conventional MRI and X-ray imaging (0.40, 95% confidence interval: 0.11-0.62). The percentage of patients exhibiting olisthesis of 3 mm or more was significantly higher on axial-loaded MRI (91%) than on conventional MRI (63%) (p<.01).

CONCLUSIONS: Axial-loaded MRI demonstrates a significantly larger degree of olisthesis than conventional MRI. In addition, the degree of olisthesis on axial-loaded MRI was found to be more strongly correlated with that observed on X-ray studies in the upright position. Furthermore, the use of axial-loaded MRI significantly reduced the misdiagnosis of olisthesis of 3 mm or more that was detected on X-ray imaging. These results suggest that axial-loaded MRI may be superior to identify the olisthesis of the lumbar spine and show the degrees of olisthesis correlated to those detected on upright X-ray imaging. Further studies should be needed to clarify the actual value of these findings on axial-loaded MRI and provide the evidence to support its clinical significance in the assessment of patients with DS.

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