• Mario Muto, Francesco Giurazza, Gianluigi Guarnieri, Rossana Senese, Emiliano Schena, Fabio Zeccolini, and Alvaro Diano.
• Neuroradiology Department, Cardarelli Hospital, Naples, Italy.
• Neuroradiology. 2016 Aug 1; 58 (8): 765-70.

IntroductionThis study aimed to determine changes in size of lumbar spinal canal and related articular structures, during dynamic MR scans acquired in symptomatic patients standing upright using a new open MR system.MethodsForty patients (mean age 58.4 years) affected by lumbar back pain associated with claudication, referring symptoms since more than 6 months. No one underwent to previous spine surgery. MR scans were performed with a novel open 0.5-T scanner, patient supine and upright (90°). Lumbar lordotic angle, flavum ligament thickness, herniated discs, spinal canal area, spinal canal and dural sac antero-posterior diameters, and spinal alignment were measured and compared in both supine and upright positions. Mean scanning time was 43 min.ResultsAll the considered parameters showed a statistically significant difference, except for lumbar lordotic angle. Mean percentage differences moving from supine to upright were +3.9 % for lumbar lordotic angle, +15 % for flavum ligament thickness, +16.2 % for sagittal disc bulge, -10.8 % for dural sac diameter, -13.1 % for spinal canal diameter, and -15.8 % for spinal canal area. In supine position, no patient presented with spondylolisthesis; moving to upright position, four patients showed spondylolisthesis (grade I).ConclusionDynamic MR is a valuable diagnostic exam to analyze the structures involved in lumbar back pain due to spinal canal stenosis and spondylolisthesis; in supine position, relevant factors can be underestimated or hidden, becoming appreciable only patient standing upright. In this series, flavum ligament thickening presented a role comparable to disc bulge for narrowing of lumbar spinal canal.

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