Dynamic Magnetic Resonance Imaging Assisted Diagnosis of Occult Spinal Instability—A New Useful Approach

Abstract

Magnetic resonance imaging (MRI) has become a global standard for confirming lumbar disc pathology, providing exceptionally detailed anatomical images. However, standard MRI taken in the typical relaxed supine position does not allow for visualization and measurement of the effects of muscle activation and movement on spinal structures. This paper describes modified dynamic MRI assessment to exploit muscular dyssynergy causing lumbar disc lesion and lumbosacral degeneration in a 30-year old man experiencing low back pain (LBP) for five years. Dynamic MRI performed during dynamic muscle activity revealed pathology that was not seen on MRI scans taken with the patient relaxed—sacral tilting and occult nerve root impingement by the L4–L5 disc. This modified imaging study was critical for a final decision to perform a surgery but also to set up appropriate rehabilitation strategy after the surgery. The paper discusses the importance of using dynamic MRI in identifying spinal movements, which may contribute to symptom presentation, and role of integrated structural and functional assessment in its treatment approach.