Neuroimaging and Interventional Radiology

Biography

Biography: Roberto Cartolari

Abstract

The comprehension of the inner mechanism of low back pain is hard and often the conventional diagnostic approach can’t reveal the exact cause of the disease. The functional radiologic study of the spine is not so precise, and only bone structures are directly seen. More complex conventional radiologic functional studies like myelography and stereo-radiology are invasive or obsolete and difficult to obtain; in any case the informations obtained are quite always “indirect”, since anatomical structures as discs, roots and ligaments are not visible. In last 20 years, a possible “in vivo” bio-mechanic approach in the study of the spine has been proposed with the use of devices like the Axial Loader and the Dynawell able to produce a variable axial load on the spine during CT or MR examinations on conventional diagnostic units. This allows to directly image all the anatomical structures in a precise way during a work. This lecture reviews the personal experience in the study mainly on the lumbar spine with the Axial Loader (AL) both in CT and in MR. The Axial Loader device is described together with the CT and MR acquisitions. The disc, intersomatic and articular facet changes obtained during the examinations are described with a breakdown of the classification of findings as Elementary Dynamic Modifications (EDMs) or Complex Dynamic Modifications (CDMs). From this data derived a possible functional model of the lumbar spine. A particular look will be given to the post-surgical functional evaluation of the lumbar spine. Early data from AL studies of pediatric isthmian lysis with MR will be presented. Finally a comparison with data from studies with MR units that allows real orthostatic spine studies will be attempted.