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Conventional Supine MRI With a Lumbar Pillow—An Alternative to Weight-bearing MRI for Diagnosing Spinal Stenosis?: A Cross-sectional Study

Hansen, Bjarke Brandt, MD; Hansen, Philip, PhD; Grindsted, Jacob, MD; Rasti, Zoreh, MD; Bliddal, Henning, DMSci; Riis, Robert G.C., MD; Boesen, Mikael, PhD∗,‡

doi: 10.1097/BRS.0000000000001889

Study Design. Cross-sectional study.

Objective. To investigate if adding a lumbar pillow in supine position during magnetic resonance imaging (MRI) is superior to standing positional MRI for diagnosing lumbar spinal stenosis (LSS).

Summary of Background Data. The upright standing position and especially extension of the lumbar spine seem to worsening symptoms of LSS. However, it is unclear whether a forced lumbar extension by a pillow in the lower back during conventional supine MRI may improve the diagnostics of LSS compared with standing MRI.

Methods. Patients suspected for LSS and referred to conventional MRI were included to an additional positional MRI scan (0.25T G-Scan) performed in: (1) conventional supine, (2) standing, (3) supine with a lumbar pillow in the lower back. LSS was evaluated for each position in consensus on a 0 to 3 semi-quantitative grading scale. Independently, L2-S1 lordosis angle, spinal cross-sectional diameter (SCSD), dural cross-sectional diameter (DCSD), and dural cross-sectional diameter (DCSA) were measured. The smallest dural diameter was defined as stenosis level and the largest control level for comparison.

Results. Twenty-seven patients (60.6 years; ±9.4) were included. The lordosis angle increased significantly from supine to standing (3.2° CI: 1.2–5.2) and with the lumbar pillow (12.8° CI: 10.3–15.3). One-way analysis of variance (ANOVA) showed significant differences between positions (P < 0.001). When compared with the supine position, pairwise comparisons showed decreased SCSD, DCSD, DCSA, and increasing semi-quantitative grading, during both standing and supine with the lumbar pillow. A difference in the semi-quantitative grades was only found between standing and supine with a lumbar pillow, and the scan with a lumbar pillow was significantly more painful.

Conclusion. Standing MRI and supine MRI with a lumbar pillow resulted in equal changes in the lumbar spine, although standing MRI may be more sensitive in the assessment of patients suspected for LSS.

Level of Evidence: 2

Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark

Department of Radiology, Zealand University Hospital Holbaek, Denmark

Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.

Address correspondence and reprint requests to Bjarke Brandt Hansen, MD, Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, DK-2000 F, Denmark; E-mail:

Received 13 April, 2016

Revised 11 July, 2016

Accepted 19 August, 2016

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

The Oak Foundation, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Savværksejer Jeppe Juhl og Hustru Ovita Juhls Mindelegat, Minister Erna Hamiltons Legat for Videnskab og Kunst and the Danish Rheumatism Association funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, payment for lectures.

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