Spine Magnetic Resonance Imaging Scans Research Articles

Magnetic resonance imaging showed no signs of overuse or permanent injury to the lumbar sacral spine during a Special Forces training course

Background context Special Forces training is even more demanding than that of elite athletes. The training includes grueling physical activity and periods of sleep deprivation. The soldiers routinely carry heavy loads up to 40% of their body weight on their backs while running and marching for distances up to 90 km. Purpose Our purpose was to find out if Special Forces recruits are able to complete the preparatory Navy Seals training program without sustaining magnetic resonance imaging (MRI) signs of overuse or irreversible injury to their backs. Study design/setting Prospective cohort study. We performed MRI scans before and after 14 weeks of Navy Seals preparatory training course. Patient sample Ten soldiers underwent MRI of their lumbar sacral spines and right knees before and after the completion of Navy Seals preparatory training. Outcome measures Physiologic measures. Lumbar sacral spine and knee MRI tests were performed before and after the training to identify changes in the spinal discs, facet joints, pars interarticularis, vertebral bodies, knee articular cartilage, ligaments, knee menisci, and the presence or absence of soft tissue and/or bone edema. Methods We investigated the difference in spine and knee pathology before and after a 14-week Navy Seals preparatory training course by using MRI criteria. The recruits participating in the study were monitored for acute and overuse injuries every 3 to 4 weeks. Results Before the training, seven out of ten spine MRI scans were normal. Two showed small L5–S1 disc bulges, one of them with concomitant Scheuermann's disease. Another soldier's MRI showed L1–L4 mild Scheuermann's disease. Follow-up MRI showed no spinal changes. Before the training, one knee had a small lateral femoral condyle cartilage lesion. Nine of ten knees had prepatellar swelling, five had increased joint fluid, and two bone edema. Follow-up magnetic resonance imaging showed improvement in the prepatellar swelling in eight soldiers, no change in one soldier, and increased knee effusion and a new medial femoral condyle bone edema in another. The lateral femoral condyle lesion remained unchanged. Conclusions According to MRI criteria, the soldiers in this study completed the 14-week training, which involved loading of their spines far beyond the levels recommended by the US National Institute for Occupational Safety and Health without sustaining irreversible damage to their spines or knees. Although the subjects' knees showed signs of overuse injury, their backs did not.

Lumbar Synovial Cyst as a Cause of Low Back Pain and Acute Radiculopathy: A Case Report

The authors report the case of a 69-year old female with a persistent history of low back pain. Plain lumbar radiographs, performed at symptom initiation, revealed lumbar spondylolisthesis. Low back pain was attributed to this, and the patient received conservative treatment with partial relief of symptoms. Four years later, and as a result of acute onset of radicular symptoms, a lumbar spine magnetic resonance imaging scan was performed, revealing an epidural cystic lesion. The cyst was removed, and histopathology revealed a synovial cyst.

Ability of anaesthetists to identify a marked lumbar interspace. (Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, United Kingdom) Anaesthesia 2000;55:1122-1126.

This article assessed anesthetists' ability to identify correctly a marked lumbar interspace in 100 patients undergoing spinal magnetic resonance imaging scans. Using ink, the first anesthetist marked an interspace on the lower spine and attempted to identify its level with the patient in the sitting position. The second anesthetist attempted to identify the level with the patient in the flexed lateral position. A marker capsule was taped over the ink mark and a routine scan performed. The actual level of markers ranged from 1 space below to 4 spaces above the level at which the anesthetist believed it to be. The marker was 1 space higher than assumed in 51% of cases and was identified correctly in only 29%. Accuracy was unaffected by patient position (sitting or lateral), although it was impaired by obesity and positioning of the markers high on the lower back. The spinal cord terminated below L1 in 19% of the patients. This, together with the risk of accidentally selecting a higher interspace than intended for intrathecal injection, implies that spinal cord trauma is more likely when higher interspaces are selected. Comment by Alan Kaye, M.D. Previous studies have demonstrated inaccuracies regarding identification of lumbar interspaces. This study by Broadbent et al involved 104 patients scheduled for lumbar magnetic resonance imaging and essentially anesthesiologists were asked to mark with washable ink the skin overlying any interspace on the lower spine after palpation of the lumbar region. Different positions were evaluated including sitting and lateral. Only 29% were demonstrated to be correct through magnetic resonance imaging. Within the lumbar region, there were tremendous errors by the anesthesiologist at all levels. Further, a common mistake included the assumption of location based on the landmark provided from the iliac crest. Therefore, with the potential of neurological damage from misidentification of the vertebral column, the authors recommend lower rather than higher sites when more than 1 site is identified. The authors provide a clever investigation; however, this is a relative small study population and there is little mention of the variation existing within the population studied. However, this study suggests that if an option exists as to which lumbar space to enter, the lower would seem safer and more prudent to minimize the potential of neurologic injury.

Ability of anaesthetists to identify a marked lumbar interspace.

Anaesthetists' ability to identify correctly a marked lumbar interspace was assessed in 100 patients undergoing spinal magnetic resonance imaging scans. Using ink, one anaesthetist marked an interspace on the lower spine and attempted to identify its level with the patient in the sitting position. A second anaesthetist attempted to identify the level with the patient in the flexed lateral position. A marker capsule was taped over the ink mark and a routine scan performed. The actual level of markers ranged from one space below to four spaces above the level at which the anaesthetist believed it to be. The marker was one space higher than assumed in 51% of cases and was identified correctly in only 29%. Accuracy was unaffected by patient position (sitting or lateral), although it was impaired by obesity (p = 0.001) and positioning of the markers high on the lower back (p < 0.001). The spinal cord terminated below L(1) in 19% of patients. This, together with the risk of accidentally selecting a higher interspace than intended for intrathecal injection, implies that spinal cord trauma is more likely when higher interspaces are selected.