Postural Changes of the Dural Sac in the Lumbar Spines of Asymptomatic Individuals Using Positional Stand-Up Magnetic Resonance Imaging

Abstract

Positional magnetic resonance imaging (MRI) study of control subjects. To determine dimensional changes in the lumbar dural sac as a function of posture, and to establish changes between the supine, erect and seated positions. Studies using computerized tomography and MRI were done to determine the mechanical effects on the lumbar spinal canal in the different positions. There has been no consecutive study, however, in which normal individuals were investigated for positional changes of the dural sac, including true standing position. Thirty-two male asymptomatic volunteers were recruited. The examination was performed using a new MRI system. All subjects were examined with sagittal T2 and axial T1-weighted spin-echo images. The subjects were studied in the supine, standing, and sitting positions. The measurements were made using OSIRIS software (Digital Imaging Unit University Hospital of Geneva, Geneva, Switzerland). On axial images, dural sac cross-sectional area and anteroposterior (AP) dural sac diameter were measured at the level of the L3/4, L4/5, and L5/S1 discs. On midsagittal images, AP dural sac diameter and the upper-endplate angles of L1 and S1 were measured. We found a disc degeneration or disc protrusion in 41% (12/29) of the subjects, but there was no obvious compression of the dural sac. Depending on the postures, the mean dural sac cross-sectional area and AP dural sac diameter changed. At all levels, mean dural sac cross-sectional area in the supine position was significantly smaller than in other postures. The dural area decreased most at the L5/S1 level due to positional change from standing to supine. The largest dural area at the L5/S1 level was in sitting extended. AP dural sac diameter on axial and midsagittal images showed a similar tendency. A significant posture-dependent difference of the dural sac cross-sectional area at the level of intervertebral disc in asymptomatic volunteers has been demonstrated. When the posture changed from supine to standing position, lumbar dural sac volume expanded by the increased pressure of cerebrospinal fluid, and the dural sac cross-sectional area increased. The smallest values were found in the supine position.