The patient presented here is a 64-year-old man who has suffered from pain in the lumbar spine for many years. 1 1/2 years ago an X-Stop implant was inserted between the spinous processes L4/L5, which led to freedom from pain. Now the patient complains again of pain lumbar with radiation to the buttocks and both thighs. There is no pain when lying down, but significant pain increase in reclination when standing and sitting, pain relief in inclination. The patient underwent Upright™ MRI, both in supine and upright sitting, in reclination and in inclination.
A-C: Sagittal images in the sitting position: Inclination, neutral position, reclination
D: Axial view at L3-L4, disc protrusion with clear narrowing of the spinal canal and impression of the dural sac.
E: Axial image at L4-L5, widening of the spinal canal by the X-Stop implant.
F: Sagittal image in supine position
Diagnosis: Longitudinal relative osseous narrowing of the spinal canal from L1-S1. Considerable additional narrowing of the spinal canal at L2/L3 and L3/L4 due to discus protrusions. Slight decrease of spinal canal stenoses under inclination and in supine position. Under reclination pronounced pincer-shaped spinal stenoses at L2/L3 and L3/L4. At L4/L5 postoperatively only indicated spinal canal stenosis. The patient’s complaints can be interpreted as claudication and the magnetic resonance imaging findings clearly show a postion-dependent spinal stenosis.