While 35 million Americans suffer from back pain, CT and MR are effective in diagnosing only a fraction of cases of back pain and sciatica. Painful conditions of the disc and facet joints, and some cases of central and lateral spinal stenosis are likely underdiagnosed by conventional CT, MR and radiographic studies.
The aims of this project have been to improve the diagnostic usefulness of CT and MR by means of precise anatomic/tomographic correlations. The correlations have identified signs by which various defects in the anulus fibrous, nucleus pulposus, ligamentum flavum and facet joints can be demonstrated with tomographic imaging. The most valuable contribution of the work to date, according to previous reviews, was the use of biomechanical techniques to model the changes produced in the spinal canal and neural foramina by loads and stresses that may be produced by normal activities. The hypothesis of this study is that central and lateral spinal stenosis are underestimated in CT and MR because patients are recumbent during the acquisition of the images. We propose in the renewal to model extension, flexion, lateral bending and rotation of the spine in cadaveric specimens. Loads will be applied with biomechanical techniques to the spine to simulate movement of the spine, displacements will be measured with kinematic techniques, and changes in anatomic relationships of the discs, facet joints, ligamentum flavum, transforaminal ligaments, and nerve roots will be studied by means of CT, MR, and cryomicrotomy. The loads and displacements and anatomic situations which result in spinal stenosis will be identified. The study is likely to provide information on the causes of radiculopathy. Except in our studies of the spinal canal and neural foramen, the transforaminal ligaments, which reduce the space available for the spinal nerves, have been disregarded. Specifically, patho-anatomic changes in the neural foramina and spinal canal will be identified in which stresses such as upright position, weight bearing, and other activities may critically narrow the neural foramina or affect spinal nerves.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR033667-06
Application #
3156625
Study Section
Diagnostic Radiology Study Section (RNM)
Project Start
1986-04-01
Project End
1996-06-30
Budget Start
1993-07-01
Budget End
1994-06-30
Support Year
6
Fiscal Year
1993
Total Cost
Indirect Cost
Name
Medical College of Wisconsin
Department
Type
Schools of Medicine
DUNS #
073134603
City
Milwaukee
State
WI
Country
United States
Zip Code
53226
Fujiwara, A; An, H S; Lim, T H et al. (2001) Morphologic changes in the lumbar intervertebral foramen due to flexion-extension, lateral bending, and axial rotation: an in vitro anatomic and biomechanical study. Spine (Phila Pa 1976) 26:876-82
Tanaka, N; An, H S; Lim, T H et al. (2001) The relationship between disc degeneration and flexibility of the lumbar spine. Spine J 1:47-56
Fujiwara, A; Lim, T H; An, H S et al. (2000) The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine (Phila Pa 1976) 25:3036-44
Haughton, V M; Lim, T H; An, H (1999) Intervertebral disk appearance correlated with stiffness of lumbar spinal motion segments. AJNR Am J Neuroradiol 20:1161-5
Schmidt, T A; An, H S; Lim, T H et al. (1998) The stiffness of lumbar spinal motion segments with a high-intensity zone in the anulus fibrosus. Spine (Phila Pa 1976) 23:2167-73
Grogan, J; Nowicki, B H; Schmidt, T A et al. (1997) Lumbar facet joint tropism does not accelerate degeneration of the facet joints. AJNR Am J Neuroradiol 18:1325-9
Nowicki, B H; Haughton, V M; Schmidt, T A et al. (1996) Occult lumbar lateral spinal stenosis in neural foramina subjected to physiologic loading. AJNR Am J Neuroradiol 17:1605-14
Inufusa, A; An, H S; Lim, T H et al. (1996) Anatomic changes of the spinal canal and intervertebral foramen associated with flexion-extension movement. Spine (Phila Pa 1976) 21:2412-20
Yetkin, F Z; Haughton, V M; Cox, R W et al. (1996) Effect of motion outside the field of view on functional MR. AJNR Am J Neuroradiol 17:1005-9
Hasegawa, T; An, H S; Haughton, V M et al. (1995) Lumbar foraminal stenosis: critical heights of the intervertebral discs and foramina. A cryomicrotome study in cadavera. J Bone Joint Surg Am 77:32-8

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