_Resonance Imaging of Spondylolysis and Spondylolisthesis峡部裂及腰椎滑脱症的磁共振成像课件.ppt

Magnetic resonance imaging of spondylolysis and isthmic spondylolisthesisPascal Niggemann – Johannes Kuchta –Dieter Grosskurth– Hans-Konrad Beyer  Janine H?ffer – Karl Stefan Delank XIX Symposium Neuroradiologicum  p.niggemann@mrt-koeln.de iWiZ Part I: Static magnetic resonance imaging Incidence of vertebral hypoplasia Impact of vertebral hypoplasia on measurement and classification Part II: Positional magnetic resonance imaging Positional MRI findings Clinical implication of positional MR findings Static magnetic resonance imaging Spondylolysis and isthmic spondylolisthesis: multi-factorial common disorder (prevalence 2.5 to 10.5 %) high prevalence in specific populations and in certain families aquired disorder => acquired disorder with a genetic predisposition Pathogenesis: facture of the pars interarticularis => spondylolysis Vertebra looses dorsal “hock” => isthmic spondylolisthesis Hypoplasia is common in patients with spondylolysis and isthmic spondylolisthesis Material: 181 patients with 184 levels of spondylolysis - 53 women /128 men 176 bilateral / 8 unilateral mean age: 50.5 ± 13.5 years Level of spondylolysis: - L5/S1: 157 patients 85 % - L4/L5: 20 patients 11 % - L3/L4: 6 patients 3 % - L2/3: 1 patient 1 % Positional MRI using the Fonar Upright MRI Scans in flexion, extension, supine and sitting position Methods I: Sagittal T2 weighted scan of the midline A B C Line A: dorsal margin of L5 Line B: parallel to line A at the dorsal edge of S1 Line C: distance between A and B Methods II: MRI in seated position using the FONAR Upright MRI = > sagittal T2 weighted scan D E Line D: lower margin of L5 Line E: upper margin of S1 Difference in size between Line A and line B in mm Methods III: C E Grade Meyerding: C divided by E in % Hypoplasia: E minus D in mm Real Spondylolisthesis: C – Hypoplasia Real Slip (Meyerding): C- Hypoplas