Lumbar Spine MRI Research Articles

The impact of the COVID-19 pandemic on neuroimaging volume in New York City.

Background and PurposeThe COVID-19 pandemic acutely disrupted all facets of healthcare, with future implications that are expected to resonate for many years. We investigated the effect of the pandemic on neuroimaging volume, hypothesizing that all representative studies would experience a reduction in volume, with those typically performed in the inpatient setting (noncontrast enhanced CT head and CTA head/neck) taking longer to recover to pre-pandemic volumes compared to studies typically performed in the outpatient setting (MR brain with and without and MR lumbar spine without).Materials and MethodsWe retrospectively queried our institution’s radiology reporting system to collect weekly data for 1 year following the World Health Organization declaration of a pandemic (11 March 2020–9 March 2021) and compared them to imaging volumes from the previous year (11 March 2019–9 March 2020). We subsequently analyzed quarterly data (e.g., first quarter comparison: 3/11/2020–6/9/2020 was compared to 3/11/2019–6/9/2019).ResultsAll studies experienced decreased volume during the first quarter of the year following onset of the COVID-19 pandemic, with noncontrast enhanced CT head failing to recover to pre-pandemic volumes. CTA head/neck actually surpassed pre-pandemic volume by the second quarter of the year. MRI brain w/wo and MRI lumbar spine without recovered to baseline volume by the second quarter.ConclusionNoncontrast enhanced CT head did not recover pre-pandemic imaging volume. CTA head/neck volume initially decreased, however volume increased above pre-pandemic levels during the second quarter; this finding may be attributable to a prothrombotic state in COVID-19 patients.

Piriformis syndrome caused by rare intramuscular lipoma: A case report

We present the case of a 73-year-old man with history of back and left sciatic nerve pain, who came to our hospital centre due to perform a lumbar spine MRI. The MRI scan didn’t reveal compression of the left nerve roots by hernia formations, but collaterally showed a well-defined lesion, with MRI characteristics of adipose tissue, localized in the left piriformis muscle, compatible with a lipoma that displaced the ipsilateral sciatic nerve but did not invade it.

Evaluation of deep learning reconstructed high-resolution 3D lumbar spine MRI.

To compare interobserver agreement and image quality of 3D T2-weighted fast spin echo (T2w-FSE) L-spine MRI images processed with a deep learning reconstruction (DLRecon) against standard-of-care (SOC) reconstruction, as well as against 2D T2w-FSE images. The hypothesis was that DLRecon 3D T2w-FSE would afford improved image quality and similar interobserver agreement compared to both SOC 3D and 2D T2w-FSE. Under IRB approval, patients who underwent routine 3-T lumbar spine (L-spine) MRI from August 17 to September 17, 2020, with both isotropic 3D and 2D T2w-FSE sequences, were retrospectively included. A DLRecon algorithm, with denoising and sharpening properties was applied to SOC 3D k-space to generate 3D DLRecon images. Four musculoskeletal radiologists blinded to reconstruction status evaluated randomized images for motion artifact, image quality, central/foraminal stenosis, disc degeneration, annular fissure, disc herniation, and presence of facet joint cysts. Inter-rater agreement for each graded variable was evaluated using Conger's kappa (κ). Thirty-five patients (mean age 58 ± 19, 26 female) were evaluated. 3D DLRecon demonstrated statistically significant higher median image quality score (2.0/2) when compared to SOC 3D (1.0/2, p < 0.001), 2D axial (1.0/2, p < 0.001), and 2D sagittal sequences (1.0/2, p value < 0.001). κ ranges (and 95% CI) for foraminal stenosis were 0.55-0.76 (0.32-0.86) for 3D DLRecon, 0.56-0.73 (0.35-0.84) for SOC 3D, and 0.58-0.71 (0.33-0.84) for 2D. Mean κ (and 95% CI) for central stenosis at L4-5 were 0.98 (0.96-0.99), 0.97 (0.95-0.99), and 0.98 (0.96-0.99)for 3D DLRecon, 3D SOC and 2D, respectively. DLRecon 3D T2w-FSE L-spine MRI demonstrated higher image quality and similar interobserver agreement for graded variables of interest when compared to 3D SOC and 2D imaging. • 3D DLRecon T2w-FSE isotropic lumbar spine MRI provides improved image quality when compared to 2D MRI, with similar interobserver agreement for clinical evaluation of pathology. • 3D DLRecon images demonstrated better image quality score (2.0/2) when compared to standard-of-care (SOC) 3D (1.0/2), p value < 0.001; 2D axial (1.0/2), p value < 0.001; and 2D sagittal sequences (1.0/2), p value < 0.001. • Interobserver agreement for major variables of interest was similar among all sequences and reconstruction types. For foraminal stenosis, κ ranged from 0.55 to 0.76 (95% CI 0.32-0.86) for 3D DLRecon, 0.56-0.73 (95% CI 0.35-0.84) for standard-of-care (SOC) 3D, and 0.58-0.71 (95% CI 0.33-0.84) for 2D.

Features of Clinical and Magnetic Resonance Imaging of Lumbar Disc Herniation

A study of 55 patients with lumbar disc herniation who were taken MRI and surgery at hospital E from January 2019 to December 2019. Results: The mean age was 58.96 ± 16.4, the female/male ratio was 1.12/1. People doing heavy work had a higher risk of disc herniation than those doing light work (63.7%). Common symptoms: lumbar pain (100%), sciatica pain, pain with mechanical properties (85.45%), limited spinal movement (90.91%), Lasègue sign (+) (74.55%), bell sign (+) (54.55%); signs of nerve root damage: sensory disturbances 72.73%, movement disorders 50.91%. Clinical lesions were common in L5 (65.45%) and S1 (45.45%) roots. Hernias were common at L4/5 (81.8%) and L5/S1 (70.9%). The degree of hernia was mainly bulge and hernia, accounting for 60% and 52.73%, respectively. 98.18% herniated to the back, central hernia accounted for the highest rate (41.82%). The rate of nerve root compression detected on MR is 90.91%. Evaluation of nerve root damage in clinical and magnetic resonance had high concordance in L5 and S1 roots (98.17% and 100%, respectively). Conclusion: MRI helps in early, accurate diagnosis and treatment orientation of lumbar disc herniation.&#x0D; Keywords: Disc herniation, MRI lumbar spine, lumbar pain. &#x0D; References&#x0D; [1] R. J. Gardocki, A. L. Park, Lower Back Pain and Disorders of Intervertebral Discs, Campbell's Operative Orthopaedics, 12th ed, Elsevier Mosby, 2013:chap 42.[2] N. V. Chuong et al., Research on Lumbar Disc Herniation at Department - Department of Internal Neurology, Hospital 103 - Military Medical Academy, Journal of Military Medicine, Vol. 3, 2015, pp. 5 - 16 (in Vietnamese).[3] S. Lee, J. H. Kang, U. Srikantha et al., Extral Foraminal Compression of the L5 Nerve Root at the Lumbosacral Junction: Clinical Analysis, Decompression Technique, and Outcome, Journal Neurosurgery Spine, Vol. 24, No. 1, 2014, pp. 1-9, https://doi.org/10.3171/2013.12.spine12629.[4] S. Eicker, S. Rhee, H. Steiger et al., Transtubular Microsurgical Approach to Treating Extra Foraminal Lumbar Disc Herniations, Neurosurgery Focus, Vol. 35, No. 2E1, 2013, pp. 1-6, https://doi.org/10.3171/2013.4.focus13126.&#x0D; [5] H. M. Cuong, Research on the Diagnosis and Surgical Treatment of Disc Herniation in the Lumbar Spine and Side Deviation by Bone Window Opening Method, Master's Thesis of Medicine, Hanoi Medical University, 2010&#x0D; (in Vietnamese).[6] J. D. Lurie, T. D. Tosteson, A. N. Tostenson et al., Surgical Versus Non-operative Treatment for Lumbar Disc Herniation: Eight-year Results for the Spine Patient Outcomes Research Trial, Spine, Vol. 39, No. 1, 2014, pp. 3-16, https://dx.doi.org/10.1097%2FBRS.0000000000000088.[7] M. R. Konieczny, R. Jeremia, M. Post et al., Signal Intensity of Lumbar Disc Herniations: Correlation With Age of Herniation for Extrusion, Protrusion, and Sequestration, Int J Spine Surg. Vol. 14, No. 1, 2020, pp. 102–107, https://doi.org/10.14444/7014.[8] M. H. Daghighi, M. Pouriesa, M. Maleki et al., Migration Patterns of Herniated Disc Fragments: a Study on 1,020 Patients with Extruded Lumbar Disc Herniation, Spine Journal, Vol. 14, No. 9, 2014, pp. 1970-1977, https://doi.org/10.1016/j.spinee.2013.11.056.[9] M. Karademir, O. Eser, E. Karavelioglu, Adolescent Lumbar Disc Herniation: Impact, Diagnosis, and Treatment, J. Back Musculoskelet Rehabil, Vol 30, No. 2, 2017, pp. 347-352, https://doi.org/10.3233/bmr-160572.[10] R. G. Menon, M. V. W. Zibetti, M. Pendola et al., Measurement of Three-Dimensional Internal Dynamic Strains in the Intervertebral Disc of the Lumbar Spine with Mechanical Loading and Golden-Angle Radial Sparse Parallel-Magnetic Resonance Imaging, J Magn Reson Imaging, Vol. 54, No. 2, 2021, pp. 486–496, https://doi.org/10.1002/jmri.27591.&#x0D; &#x0D; &#x0D;

Paraspinal soft tissue edema ratio: An accurate marker for early lumbar spine spondylodiscitis on an unenhanced MRI

PurposeMRI is currently the gold standard imaging modality in the diagnosis of lumbar spine discitis/osteomyelitis. However, even with supportive clinical and laboratory data, the accuracy of MRI remains limited by several degenerative and inflammatory mimics, such that it continues to represent a challenge for radiologists. This study reports a new quantitative imaging marker of lumbar paraspinal soft tissue edema which shows significant accuracy for spondylodiscitis. MethodsThirty-five patients with equivocal MRI findings of lumbar discitis/osteomyelitis vs endplate degenerative changes were reviewed over a 24-month period. Patients with a history of surgery, fractures/recent trauma, signs of advanced infection such as abscesses, phlegmon or severe osseous destruction were excluded. Two ABR board certified neuroradiologists who were blinded to the final diagnosis evaluated a new marker; the superior-inferior paraspinal edema ratio (SI-PER). The SI-PER was obtained by measuring the superior-inferior extent of increased signal/edema in the paraspinal soft tissues on the paraspinal inversion recovery images divided by the vertebral body height measured at midpoint. Cases positive for spondylodiscitis were those confirmed by biopsy, aspiration/drainage, surgery, or clinical improvement following antibiotic treatment. The diagnostic sensitivity and specificity of SI-PER were determined by Receiver operating characteristic (ROC) analysis. ResultsIn 23/35 (66%) patients, the diagnosis of discitis/osteomyelitis was confirmed. The SI-PER showed a significant association with a positive MRI diagnosis (p = 0.001). Inter-observer correlation for SI-PER was 0.92. ROC analysis showed an area under the curve of 0.84. A SI-PER of 2.5 was 96% sensitive and 75% specific for the diagnosis of discitis/osteomyelitis, with a PPV of 88% and a NPV of 90%. ConclusionIn this study, the superior inferior paraspinal edema ratio (SI-PER), a newly defined MRI marker, was found to have high sensitivity for differentiating spondylodiscitis from endplate degenerative changes on lumbar spine MRI.

Automated selection of mid-height intervertebral disc slice in traverse lumbar spine MRI using a combination of deep learning feature and machine learning classifier.

Abnormalities and defects that can cause lumbar spinal stenosis often occur in the Intervertebral Disc (IVD) of the patient's lumbar spine. Their automatic detection and classification require an application of an image analysis algorithm on suitable images, such as mid-sagittal images or traverse mid-height intervertebral disc slices, as inputs. Hence the process of selecting and separating these images from other medical images in the patient's set of scans is necessary. However, the technological progress in making this process automated is still lagging behind other areas in medical image classification research. In this paper, we report the result of our investigation on the suitability and performance of different approaches of machine learning to automatically select the best traverse plane that cuts closest to the half-height of an IVD from a database of lumbar spine MRI images. This study considers images features extracted using eleven different pre-trained Deep Convolution Neural Network (DCNN) models. We investigate the effectiveness of three dimensionality-reduction techniques and three feature-selection techniques on the classification performance. We also investigate the performance of five different Machine Learning (ML) algorithms and three Fully Connected (FC) neural network learning optimizers which are used to train an image classifier with hyperparameter optimization using a wide range of hyperparameter options and values. The different combinations of methods are tested on a publicly available lumbar spine MRI dataset consisting of MRI studies of 515 patients with symptomatic back pain. Our experiment shows that applying the Support Vector Machine algorithm with a short Gaussian kernel on full-length image features extracted using a pre-trained DenseNet201 model is the best approach to use. This approach gives the minimum per-class classification performance of around 0.88 when measured using the precision and recall metrics. The median performance measured using the precision metric ranges from 0.95 to 0.99 whereas that using the recall metric ranges from 0.93 to 1.0. When only considering the L3/L4, L4/L5, and L5/S1 classes, the minimum F1-Scores range between 0.93 to 0.95, whereas the median F1-Scores range between 0.97 to 0.99.

A MORPHOMETRIC STUDY OF VENTRAL NERVE ROOTS AND RETROPERITONEAL VESSELS IN RELATION TO A MINIMALLY INVASIVE LATERAL APPROACH TO DETERMINE SAFE WORKING ZONE

Background: The minimally invasive lateral retroperitoneal transpsoas approach is a new method that was designed to minimize problems related with standard or minimally invasive anterior or posterior lumbar spine techniques. The current work used magnetic resonance imaging to determine the anatomic location of the ventral root and retroperitoneal arteries in respect to the vertebral body and to establish the anatomical safe zones. We examined lumbar spine MRI in 50 individuals retrospectively (L1-L2 to L5-S Method: 1 levels). The ventral root and surrounding major arteries were identied using axial T1 and T2 scans. Axial MR scans were utilized to determine the anterior-posterior (AP) diameter of the vertebral endplate, the overlap between the ventral root and the posterior border of the vertebra, and the overlap between the retroperitoneal big vessels and the anterior edge of the vertebra. The safe zone was then determined. From L1–L2 Results: to L5–S1, the mean AP diameter of the vertebral body and the overlap of the vertebral body with the nerve roots and retroperitoneal arteries grew gradually. When we examined the extent of overlap of retroperitoneal arteries with the ventral border of the lower vertebral body endplate, we discovered that the right vascular structures were more posterior than the left vascular structures. The safe working zone was 81.86 percent of the lower endplate of the sagittal diameter of the vertebral body at L1–L2, 70.03 percent at L2–L3, 69.32 percent at L3–L4, 50.08 percent at L4–L5, and 17.92 percent at L5–S1 levels. The Conclusion: retroperitoneal transpsoas method is a less invasive and more efcient alternative to the conventional posterior, open lumbar procedures. It can be used to treat trauma, degenerative disc disease, adult degenerative scoliosis, spondylosis with instability, spondylolisthesis, lumbar stenosis, and neighboring segment failure.

Spontaneous Regression of Disc Prolapse – An Underlooked Phenomena: A Case Report and Literature Review

Introduction: Intervertebral disc prolapse is a very common abnormality found in the population, that can manifest in a variety of complaints like back pain, radiculopathy, and even to the extent that it might lead to more adverse neurological deficits. Symptoms improve in majority of patients only with conservative treatment. However, some patients may require surgical intervention. In some cases, spontaneous regression of herniated disc can be seen. Thus, the interest in the phenomenon of spontaneous resorption of the herniated discs has increased, which raised the controversy regarding managing such patients. Here, we report a case of a huge lumbosacral spontaneous disc resolution at the level of L5-S1 in which clinical improvement was associated with a significant decrease in the size of a huge, herniated disc. In addition, we performed a comprehensive review of literature of all reported cases of spontaneous disc resolution to provide an updated discussion of such an underlooked phenomena.&#x0D; Case Report: A 53-year-old female not known to have any medical illness presented at the Neurosurgery Clinic with complaints of chronic back pain for six years which was progressing and radiating to both of her lower extremities (right more than left) and had become more intense in the last year. It was slightly relieved by simple analgesics and aggravated by sitting or lying down. There was no history of trauma, weaknesses, or sphincteric disturbances. Upon evaluation in our clinic, local exam revealed lower back midline tenderness at the level of L5-S1 vertebrae. No tenderness was observed in the paravertebral area or facets. Straight leg raising test was positive at 70º in the right side and 90º in the left, normal power, intact sensation, normal tone, and reflexes. Negative Babinski and clonus was noted in both limbs. MRI lumbar spine showed significant right paracentral L5-S1 disk prolapse indenting the thecal sac compressing the root. A full-course and effective medical treatment was initiated as the patient was never treated properly before for her back pain, along with physical therapy and regular OPD follow-ups. A follow-up MRI a year later revealed significant reduction in the size of the disk prolapse as compared to the initial imaging study. Overall, patient’s symptoms significantly improved, and she was kept on conservative management.&#x0D; Conclusion: To conclude, the case presented here shows the efficacy and validity of conservative management for patients who are diagnosed with a herniated disc in the absence of neurological deficits. This shows the importance of not pushing surgical treatment for patient with lumbar disc herniation without neurological deficits, each patient should receive a trial of conservative therapy and close OPD follow-ups and repeated MRI scans for further assessment of any advancement or improvement, because herniated discs can regress spontaneously. Radiological changes alone should not be the main target for assessing improvement, what matters more is clinical and symptomatic improvement. Surgical management remains an important therapeutic option for patients who failed conservative management and patients who have severe neurological deficits.

339 The Glasgow Lumbar Spinal Stenosis Scale: An Individualised Measurement Formula for the Radiological Assessment of Lumbar Spinal Stenosis

Abstract Background Lumbar spinal stenosis (LSS) is a common spinal problem. Currently there is no universally accepted quantitative approach to the radiological measurement of LSS. Quantitative descriptions do exist, but these are unidimensional and do not consider normal variation in anatomy. We propose a universal and individualised measurement system for the quantitative radiological assessment of lumbar spinal stenosis. Method A retrospective case series of patients who had undergone surgery for symptomatic lumbar spinal stenosis over a 3-year period. Pre-operative T2 weighted lumbar spine MRI were analysed. Each patient had the degree of lumbar canal stenosis quantified using our approach. Results Our novel formula for the quantitative radiological assessment of LSS is two dimensional, repeatable, and presented as a percentage, to correct for the individual patient. The surface area of the canal at the level of stenosis is measured (mm2). The adjacent 2 levels are then measured and averaged. The calculation becomes (A-S/A) x 100 = R, where S is the canal surface area at the stenosed level, A is the average canal surface area of the two levels adjacent to the level of interest and R is the relative degree of lumbar spinal canal stenosis expressed as a percentage. Conclusions This novel quantitative measurement formula for the radiological assessment of lumbar canal spinal stenosis is quick and simple to calculate and most importantly adjusts for the individual patient’s normal or degenerative anatomy. This new measurement tool will need validation against specific clinical and operative criteria in the future.

The Association of Lumbosacral Transitional Vertebrae with Low Back Pain and Lumbar Degenerative Findings in MRI: A Large Cohort Study.

A cross-sectional study of the Northern Finland Birth Cohort 1966 (NFBC1966). To evaluate the association of lumbosacral transitional vertebrae (LSTV) with low back pain (LBP) and associated degenerative findings using magnetic resonance (MR) imaging. LSTV is a common finding with a prevalence of 10% to 29%. LSTV causes biomechanical alterations leading to accelerated lumbar degeneration. However, its association with degenerative findings on MRI and LBP is unclear. One thousand four hundred sixty eight lumbar spine MRI scans from the NFBC1966 acquired at a mean age of 47 years were assessed for the presence of LSTV and degenerative changes. Castellvi classification was utilized to identify LSTV anatomy. Additionally, 100 controls without LSTV were collected. Self-reported LBP with a duration of more than 30 days in the past year was deemed clinically relevant. For the statistical analyses, chi square test, independent samples t test and multinomial logistic regression analyses were used. LSTV was found in 310 (21.1%) subjects. After adjusting for age, sex, and disc degeneration (DD) sum, subjects with Castellvi type III reported prolonged LBP significantly more frequently than the controls (odds ratio [OR] = 8.9, P = 0.001). We observed a higher prevalence of facet degeneration (FD) at all levels from L3/L4 to L5/S1 in type I, and L3/L4 to L4/L5 in types II-IV. DD was more prevalent at L4/L5 in types II-IV. Disc protrusion/extrusion occurred more frequently at L3/L4 and L4/L5 in type II, and at L3/L4 in type III. Castellvi type II had a higher prevalence of type 1 Modic changes at levels from L3/L4 to L4/L5. LSTVs were a common finding within this study, and Castellvi type III LSTVs were associated with LBP. Degenerative findings were associated with LSTV anatomy and occurred more commonly above the transitional level.Level of Evidence: 3.

Extraspinal incidental findings and reporting rates at lumbar spine magnetic resonance imaging: more than a spinal examination?

Aim: To reveal the prevalence characteristics of extraspinal findings incidentally detected in lumbar spinal MRI examinations, determine their rate of reporting status, and analyze the findings in terms of clinical significance and patient benefit in order to help prevent possible medicolegal and ethical problems. Material and Methods: A total of 2,912 lumbar MRI examinations were retrospectively reviewed. The extraspinal findings were identified and analyzed according to their clinical significance. MRI examination reports were analyzed and whether extraspinal findings were included in these reports was determined. Results: The study included a total of 2,912 patients, of whom 41% (n=1,195) were male and 59% (n=1,717) were female. The mean age of all patients was 48.25±15.92 (8-90) years. The mean age of men was 47.31±16.96 (9-90) and that of women was 48.91±15.12 (8-90) years. Extraspinal findings were present in 29% (n=844) of the patients and absent in 71% (n=2,068). The number of extraspinal findings 1 for 25.10% (n=731) of the patients, 2 in 3.61% (n=105), 3 in 0.24% (n=7), and 4 in 0.03% (n=1), with the total number being determined as 966. Conclusion: Lumbar MRI images should be more carefully examined during the reporting stage and clinical evaluation in order to prevent possible morbidity-mortality situations by making accurate and early referrals in patient management and to avoid ethical-judicial problems that physicians may face due to the inability to recognize existing pathologies that may be outside the targeted area.

99. The association of spinal lean muscle volume on lumbar spine MRI and regional volumetric bone mineral density measured by quantitative computed tomography

<h3>BACKGROUND CONTEXT</h3> Low muscle volume, also called sarcopenia, is a common condition of aging with a prevalence between 1 and 29% in populations over the age of 50 years. Previous studies have demonstrated evidence that both osteoporosis and sarcopenia coexist, called osteosarcopenia, and these patients are at greater risk for falls, fractures and mortality. In osteoporotic post-menopausal female patients, the prevalence of sarcopenia is around 50%. Recent studies showed that sarcopenic subjects had a 4-fold higher risk of coexisting osteoporosis compared with nonsarcopenic individuals. However, a limited number of studies have been conducted in spine surgery patients. <h3>PURPOSE</h3> The aim of this study is to investigate the associations between the lean muscle volume (LMV) in paraspinal and proas muscle on MRI and quantitative computed tomography (QCT) volumetric bone mineral density (vBMD) in the lumbosacral region. <h3>STUDY DESIGN/SETTING</h3> A cross-sectional analysis of a prospectively maintained database at a single academic institution. <h3>PATIENT SAMPLE</h3> Patients undergoing posterior lumbar fusion surgery between 2014-2020. <h3>OUTCOME MEASURES</h3> Volumetric BMD measured by QCT in the lumbar spine and sacral ala. <h3>METHODS</h3> We reviewed an institutional database of posterior lumbar fusion patients. Patients who had ongoing antiosteoporotic therapy with bisphosphonate, denosumab or teriparatide were excluded. Muscle measurements were conducted utilizing a free software program (ITK-SNAP version 3.8) setting regions of interest (ROI) in the bilateral psoas and paraspinal (erector spinae and multifundus) muscles on preoperative T2-weighted axial MR images at the mid-L3 level. The area of fat-free muscle (LMV: lean muscle volume) was calculated using a custom written program on Matlab™ (MATLAB version 2019a, The MathWorks, Inc, Natick, MA, USA). QCT measurements were performed on preoperative CT scans using the Mindways QCT Pro Software (Mindways Software, Inc., Austin, TX, USA). QCT-vBMDs in the standard L1-L2 and bilateral sacral ala were analyzed. Pearson's correlation and linear regression analyses adjusting with age and BMI were performed. Since muscle volume is strongly affected by biological sex, we stratified by sex for all analyses. Statistical significance was set <0.05. <h3>RESULTS</h3> Out of 144 patients, 30 patients were excluded due to QCT incompatible CTs or poor quality MRIs for muscle volume measurements. An additional 9 patients were excluded due to ongoing anti-osteoporotic drug therapy. A total of 105 patients (50 male and 55 female) were included in the final analysis. In female patients, there were statistically significant mild to moderate positive correlations between L1-L2 vBMD and LMV in paraspinal and psoas muscles, as well as sacral ala vBMD and paraspinal LMV, whereas there was no significant correlation in male patients. After the adjustment with age and BMI, high paraspinal LMV was an independent factor for high sacral ala vBMD (β=0.04 (95%CI: 0.00-0.14), p=0.040) and high psoas LMV was significantly associated with high L1-L2 vBMD (β=0.04 (95%CI: 0.01-0.14), p=0.025). <h3>CONCLUSIONS</h3> Our results demonstrated that higher lean muscle volume was significantly associated with higher vBMD in the lumbosacral lesions in women. This association was not observed in men. This might indicate gender differences should be considered for the assessment of osteosarcopenia in spine surgery patients. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

An Uncommon Cause Of Persistent Back Pain In A Dancer

HISTORY: A 16-year-old dancer presented with 3 months of lower back pain that gradually increased with time without any clear inciting events. Pain was greater on the right, worse with extension and relieved with flexion. Quality was sharp and aching without radicular symptoms. PHYSICAL EXAM: Spine alignment was normal. There was no midline, paraspinal, nor SI joint tenderness. Spine flexion was painless. Spine extension, facet loading, and stork test bilaterally provoked pain. Motor strength was grossly 5/5 and sensation was intact at all dermatomes. Faber was positive. DIFFERENTIAL DIAGNOSIS: 1 Spondylolysis 2 Disc herniation 3 Baastrup’s disease 4 Spinous process apophysitis TESTS AND RESULTS: MRI lumbar spine was negative for spondylolysis, spondylolisthesis, and disc herniation. Interspinous bursitis and facet arthropathy were found at L4-5 and L5-S1. FINAL/WORKING DIAGNOSIS: Baastrup’s disease typically affects older adults. However, as this case demonstrates, young athletes who perform repetitive spinal extension such as gymnasts and dancers may also suffer from this. Patients present with midline tenderness, pain exacerbated by extension and relief with flexion. Young athletes may be frustrated by negative workups since few providers actively evaluate for this. Repetitive stress on interspinous ligaments and spinous processes can lead to instability and pain from abutting hypertrophic spinous process and adventitious bursas. In adults, imaging may show approximation and sclerosis of spinous processes. In young athletes, MRIs may show only interspinous bursal fluid. Conservative treatment with rest from spine extension, therapy, and spine flexion exercises has some success. It is difficult to treat in athletes because of the extensive rest time required for bursitis to improve. It may require interventional injections if chronic. TREATMENT AND OUTCOME: NSAIDS were prescribed and dance was modified to avoid spine extension. PT was done for core stabilization and to correct biomechanics. Her pain remained unchanged after 1 year. She completely refrained from dance and continued core strengthening for an additional 2 months before resumption of dance with some improvement. She was offered but deferred injections to the interspinous ligamentous bursa, choosing to continue to modify her dance.

Postoperative lumbar spine MRI: How well does a radiology report that raises suspicion for infection correlate with true clinical infection?

IntroductionInterpretation of a lumbar spine MRI in the immediate postoperative period is challenging, as postoperative tissue enhancement and fluid collections may be mistaken for infection. Radiology reports may use ambiguous language, creating a clinical problem for a surgeon in determining whether a patient needs treatment with antibiotics or revision surgery. Moreover, retrospective criticism of management in instances of a true infection may lead to medicolegal ramifications. MethodsA retrospective review of patients undergoing posterior-approach lumbar decompressive surgery with or without fusion over a 30-month period identified those undergoing postoperative MRI within 10 weeks of surgery. Patients initially operated upon for infection were excluded. The MRI reports were analyzed for language describing findings suspicious for infection and those of these with true infections were identified. ResultsOf 487 patients undergoing posterior lumbar spine decompression surgery, 68 (14%) had postoperative MRI within 10 weeks. Of these, the radiology reports raised suspicion for infection in 20 (29%), of which 2 (10%) patients had a true infection. Two patients underwent reoperation for new motor deficit from seroma/hematoma. Of 63 patients who had MRI to evaluate complaints of back and/or leg pain without new motor deficits, the MRI significantly altered management in 3 patients (4.8%). ConclusionRadiology reports of postoperative lumbar spine MRIs frequently use language that raises suspicion for infection; but it is uncommon, however, that these patients harbor true infections. A radiology report describing possible infectious findings may not be considered significant without corroboration with other laboratory and clinical data.

The glasgow lumbar spinal stenosis scale: an individualised measurement formula for the radiological assessment of lumbar spinal stenosis

Background Lumbar spinal stenosis (LSS) is a common and important spinal surgical problem. Currently there is no universally accepted quantitative approach to the radiological measurement of LSS. LSS can be described qualitatively with reference to facet and ligamentous hypertrophy, lack of perineural or intraforaminal fat, and reduced CSF around the cauda equina. Quantitative descriptions do exist e.g., lumbar canal antero-posterior diameter, but these are unidimensional and do not consider normal variation in anatomy. We propose a universal and individualised measurement system for the quantitative radiological assessment of lumbar spinal stenosis. Methods A retrospective case series of patients who had undergone surgery for symptomatic lumbar spinal stenosis over a 3 year period. Pre-operative lumbar spine MRI were analysed. Each patient had the degree of lumbar canal stenosis quantified using our novel approach. Results Our novel formula for the quantitative radiological assessment of lumbar spinal stenosis is two dimensional, repeatable and presented as a percentage, to correct for the individual patient. The surface area of the lumbar spinal canal at the level of stenosis is measured in mm2 plus the adjacent 2 levels which are then averaged. The calculation then becomes (A-S/A) x 100 = R, where S is the canal surface area at the stenosed level in mm2, A is the average canal surface area of the two levels adjacent to the level of interest and R is the relative degree of lumbar spinal canal stenosis expressed as a percentage. Measurements are calculated using axial T2 weighted images. Conclusions This novel quantitative measurement formula for the radiological assessment of lumbar canal spinal stenosis is quick and simple to calculate and most importantly adjusts for the individual patient’s normal or degenerative anatomy. This new measurement tool will need validation against specific clinical and operative criteria in the future.

Quantitative correlation of lumbar foraminal stenosis with local morphological metrics.

Clinical evaluation of lumbar foraminal stenosis typically includes qualitative assessments of perineural epidural fat content around the spinal nerve root and evaluation of nerve root impingement. The present study investigates the use of several morphological MRI-derived metrics as quantitative predictors of foraminal stenosis grade. 62 adult patients that underwent lumbar spine MRI evaluation over a 1-month duration in 2018 were included in the analysis. Radiological gradings of stenosis were captured from the existing clinical electronic medical record. Clinical gradings were recorded using a 0-5 scale: 0 = no stenosis, 1 = mild stenosis, 2 = mild-moderate stenosis, 3 = moderate stenosis, 4 = moderate-severe stenosis, 5 = severe stenosis. Quantitative measures of perineural epidural fat volume, nerve root cross-sectional area, and lumbar pedicle length were derived from T1 weighted sagittal spine MRI on each side of all lumbar levels. Spearman correlations of each measured metric at each level were then computed against the stenosis gradings. A total of 347 volumetric segmentation and radiological foraminal stenosis grade sets were derived from the 62-subject study cohort. Statistical analysis revealed significant correlations (p < 0.001) between the volume of perineural fat and stenosis grades for all lumbar vertebral levels. The results of the study have demonstrated that segmented volumes of perineural fat predict the severity of clinically scored foraminal stenosis. This finding motivates further development of automated perineural fat segmentation methods, which could offer a quantitative imaging biometric that yields more reproducible diagnosis, assessment, and tracking of foraminal stenosis.

Post-Medicare Access and CHIP Reauthorization Act of 2015 Trends in Lumbar Magnetic Resonance Imaging Use for Patients with Low Back Pain at 1373 Hospitals

Lumbar Spine MRI Use for Low Back Pain (OP-8) is calculated by dividing the number of patients who received lumbar magnetic resonance imaging (MRI-L) before receiving alternative treatments (e.g., physical therapy) by the total number of patients receiving MRI-L in the outpatient setting at a given institution. Since the passage of the Post-Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), OP-8 scores became tied to hospital finances. This study aims to determine how MACRA has impacted OP-8 scores since its implementation. We also aim to investigate how regional designation, profit status (for-profit, government, and nonprofit), and hospital setting (critical access, non-critical access) affect OP-8 scores. Data from the Centers for Medicare and Medicaid Services Hospital Compare database were used to extract information on the national trends in OP-8 scores from 2014 to 2020. A multivariable linear regression model was fit to isolate the impact of hospital characteristics on OP-8 scores. After a decrease from 2015 to 2016, the mean national OP-8 score plateaued, staying around 40% from 2017 through 2020. A critical access setting increased OP-8 scores by 5.41 (95% confidence interval, 3.51-6.77; P ≤ 0.001), compared with a non-critical access setting. Governmental status increased scores by 1.27 (95% confidence interval, 0.28-2.27; P= 0.012), compared with a nonprofit status. The implementation of MACRA seems to have been unsuccessful in altering practice patterns, given the minimal change in OP-8 scores over the last 4 years. Furthermore, institutional factors are clearly correlated with a lack of adherence to magnetic resonance imaging guidelines. Given these findings, there is a need to modify health policies.

Lumbar Thecal Sac Dimensions and Axial Spinal Cord Areas on Magnetic Resosnace Imaging in 626 Healthy Subjects.

A cross-sectional study. The aim of this study was to investigate the lumbar thecal sac dimensions and spinal cord area on magnetic resonance (MR) imaging in healthy volunteers. There are few reports regarding lumbar spine MRI in healthy subjects, and the difference in spinal canal dimensions by age remains unclear. A total of 629 healthy volunteers were enrolled, including ≥50 males, females, and subjects in each of the 20s to 70s age decades. The anteroposterior and transverse diameters of the thecal sac and axial areas of the thecal sac and spinal cord were measured at the disc levels on T2-weighted axial MR images. The anteroposterior-to-transverse ratio of the thecal sac (APTR) was calculated. The thecal sac area from T12/L1 to L4/5 was reduced in older age group, but there was no significant difference in L5/S1. The thecal sac area was significantly reduced in older age group: 89.9%, 86.0%, 84.6%, 80.3% at T12/L1, L1/2, L2/3, and L3/4, respectively, and 79.9% at L4/5 in subjects in their 70 s relative to that in subjects in their 20 s. The APTR was significantly reduced in older age group from T11/12 to L2/L3 in males and at T10/11, L3/4 and from T11/12 to L2/3 in females. Narrow thecal sac areas <80 mm2 were found in 10 subjects. The spinal cord area was significantly reduced in older age group at T10/11 in males and at T9/10, T10/11, and T11/12 in females. The area was 92.0% at T10/11 in subjects in their 70s relative to the area of subjects in their 20s. The thecal sac area was reduced in older age group from T12/L1 to L4/5, and the thecal sac area was reduced in the anteroposterior and all directions in the upper and lower lumbar area in age group, respectively. Approximately, 3.0% of healthy population in their 50s or older will have severe asymptomatic stenosis.Level of Evidence: 2.

Lumbar Spine MR Imaging : Relation Between Edema Like Signal in the Posterior Soft-Tissue and Body Mass Index

Background: It is not uncommon to encounter edema like signal within the soft tissue of the posterior lumbar region in MRI of the spine; however the exact explanation of such edema is not established yet. Objectives: To find out relationship between edema like lesion in the soft tissue of the posterior lumbar region on spine MRI with BMI, age and gender Patients and Methods: Lumbar Spine MRI of 288 outpatients suspected to have disc disease ( 150 females and 138 males ) performed on 1.5 Tesla facility was evaluated. Subjects with systemic or local disease likely to produce edema were excluded to obtain healthier subjects. The scans were reviewed for presence, site, and degree of High T2 edema like signal within the posterior lumbar soft tissue . The subjects were divided into four subgroups according to BMI and two groups according to their age(≤50 or>50 years old). The edema was scored from 0-5 based on its length relative to vertebral-body height. Correlation between the presence and extent of edema was made with BMI, age and gender . Results :Among the 288 cases, 116 (40%)patients had lumbar soft tissue edema. Association was found between the degree of edema and BMI ( P= .001) and with age ( P= .041) . The presence of edema was noticed to be significantly more among women (P=.045) , while the average level of edema epicenters was approximately similar ( L3.6 and L 4 consequently, P = .58). Conclusion :There is a positive relationship between the frequency and extent of posterior lumbar soft tissue edema with BMI and age .

Observer agreement in the choice of lumbar spine injection for pain management.

Lumbar spine MRI can help guide the choice of corticosteroid injection in pain management. We investigated whether patient-reported symptom information from a questionnaire could improve agreement in the choice of type, level, and side of injection. In this prospective observational study, 120 patients (median age 64, 70 men) were recruited from patients referred for pain management. After informed consent, they completed electronic questionnaires that obtained symptom information for later use during MRI reviews. In 3 research arms, 6 radiologists chose injections that would ideally deliver corticosteroid to the presumed sources of pain in (1) MRI studies reviewed with symptom information from questionnaires, (2) MRI studies reviewed without symptom information, and (3) MRI reports. Blinded to questionnaire results, radiologists providing clinical care and interviewing patients chose ideal therapeutic injections to establish reference standards. Injections were categorized by type, level, and side and compared using percent agreement and kappa statistics. Interreading agreement was analyzed. Compared to the reference standard, kappa agreements for injection types, levels, and sides were almost perfect when MRIs were reviewed knowing symptoms (0.85-0.93), fair without symptoms (0.23-0.35) (all P < .001) and fair in MRI reports (0.24-0.36) (all P < .001). Interreading kappa agreements were almost perfect knowing symptoms (0.82-0.90), but only moderate without symptoms (0.42-0.49) (all P < .001). Radiologists reviewing lumbar spine MRI converged on the type, level, and side of ideal therapeutic injection whether they obtained symptom information from direct patient interview or electronic questionnaire. Observer agreement was significantly lower without symptom information.