Severe Spondylolisthesis Undetected by Recumbent MRI Clinical Case Overview During the year following surgery, the patient sought help from multiple medical specialists. She provided her recumbent MRI images to them. She was told the images showed nothing that could account for her symptoms and that nothing more could be done. Her surgeon rejected the prospect of additional surgery. A Florida neurologist suggested to her that her problem was all “in her head.”
The patient was scanned in the patented FONAR Upright™ MRI in early 2002, one year after her spinal fusion. Both Upright™ and recumbent scans were performed on her in the multi-position FONAR Upright™ MRI. The recumbent MRI (left image) exhibited only a normal lumbar lordotic curve and a modest bulge of the L3-4 intervertebral disc, consistent with her prior recumbent MRI scans. The FONAR Upright™ scan (right image) revealed, however, a marked position-dependent subluxation (anterolisthesis) at L3-4 and an accompanying spinal stenosis that were not visible on the recumbent MRI. The patient's Upright™ images established that there was a genuine physical basis for her symptoms, whereas her recumbent MRI images had failed to do so. The new Upright™ images supplied her surgeon with the necessary evidence that additional surgery was warranted to correct her problem. A spinal fusion was performed at L3-4 one month after the patient's Upright™ MRI scan. The surgical outcome was positive. To date, almost four years post-op, the patient remains symptom free and reported to FONAR, "Thank you for giving me my life back." * laminectomy and L45S1 fusion
Clinical Case Overview Prior to the Upright™ scan, the patient was scanned in a recumbent-only MRI (1.5T). It showed a right paracentral disk herniation at L5-S1. Based on the recumbent images, neurosurgeon Bennie W. Chiles III, M.D., said:
“I would have likely performed a diskectomy at L5-S1 to relieve pressure on the nerve root, along with an L5-S1 fusion for the back pain. Fusing L4-5 was not an initial consideration because no spinal instability was seen on the recumbent MRI. When the dynamic flexion and extension images performed in the Upright™ MRI demonstrated an instability at L4-5 and showed the full extent of that instability once the patient’s body weight was applied, I chose to also fuse L4-5 during the procedure rather than treat L5-S1 alone. The result was a better outcome for the patient whose severe right leg pain is now gone and whose back pain is much reduced.” Case study courtesy of Bennie W. Chiles III, M.D., F.A.C.S., Westchester Spine and Brain Surgery, PLLC (Hartsdale, New York), and Upright Imaging of Westchester, P.C. (Yonkers, New York) |
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The imaging center that evaluated her recommended she be scanned in an Upright™ MRI due to the possibility that an Upright™ scan, unlike the conventional recumbent scan, is weight-bearing and "might uncover something." Her family physician wrote the prescription, and the patient drove from her home in the Florida panhandle to the closest FONAR Upright™ MRI center, which at the time was in Tampa over 425 miles away.
