The Role of Dynamic Magnetic Resonance Imaging in Improving the Accuracy of Diagnosis of Degenerative Diseases of the Lumbosacral Spine

Abstract Background Low back pain (LBP) is one of the most common musculoskeletal complaints, the life time prevalence of low back pain may be up to 80% in the industrialized countries and is one of the main causes of sick leave and disability pension with huge personal and socioeconomic consequences. Low back pain causes more disability than any other condition, and global point prevalence has been calculated at 9.4%. Aim of the Work To evaluate the role of dynamic MRI in assessment of degenerative diseases of lumbosacral spine compared to conventional MRI regarding assessment of spinal instability and evaluating the degenerative changes in flexion and extension in comparison to neutral position to determine best clinical management and outcome for the patients. Patients and Methods A prospective study conducted on patients who was referred to the Radiology Department –MRI unit at Ain Shams University Specialized Hospital presented with symptoms of degenerative lumbar spine disease. The study was conducted at Ain Shams Specialized University Hospital. Results upon follow up with the spine surgeon and surveying the patients’ level of pain, surgery with thecal sac decompression with/without spinal fixation on the suggested levels was done, 75% of the patients showed postoperative clinical improvement. We have also to point out that dynamic MRI is a helpful tool for preventing unnecessary surgical intervention by making the orthopedic surgeon more confident about choosing the conservative management for the patient, this is reinforced by confidently ruling out the presence of spinal instability, presence of exaggerated neural foraminal compromise or spinal canal stenosis in certain position. In our study each patient had conventional and dynamic MRI study and accordingly the management plan was determined by the orthopedic physician, 70.3% was advised for conservative management with marked improvement of the pain level of the patient after 3 months of compliance of conservative management (91.6%) of the patients showed improvement. In 24.3% of the patients the treatment plan was changed from conservative to surgical intervention after performing dynamic MRI with 75 % showing improvement after surgical intervention. The evaluation of the patient’s pain level and outcome after the management plan taken according to the dynamic MRI showed significant improvement (p value 0.01). Conclusion functional imaging tools; like dynamic MRI of the lumbar spine, allows better visualization of hidden pathologies in conventional MRI especially with patients with clinical/radiological mismatch therefore it gives the spine surgeon a helpful tool in order to understand and explain patients’ symptomatology. It also provides documented proof of neural compression and hence facilitates accurate preoperative planning regarding the procedure and the target level, and accordingly better postoperative outcome.