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Axial Rotation of the Lumbar Spinal Motion Segments Correlated with Concordant Pain on Discography: A Preliminary Study

Donna G. Blankenbaker1, Victor M. Haughton1, Baxter P. Rogers2, M. Elizabeth Meyerand2 and Jason P. Fine3

1 Department of Radiology, University of Wisconsin Medical School, Clinical Science Center-E3/311, 600 Highland Ave., Madison, WI 53792-3252.
2 Department of Medical Physics, University of Wisconsin, Madison, WI 53706.
3 Department of Statistics and Department of Biostatistics & Informatics, University of Wisconsin, Madison, WI 53792-3252.


Figure 1
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  		Fig. 1 —Image shows table insert that provides clockwise and counterclockwise rotation at lumbar spine. Inset is placed on CT gantry. Patient is positioned on insert with head and thorax on longer segment and hips on shorter segment. Each segment is on rollers that permit them to rotate 8° clockwise and counterclockwise with the axis of rotation 10 cm above segment so that spine is at isocenter of rotation.

 

Figure 2
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  		Fig. 2A —Images illustrating CT data acquired for calculation of vertebral rotation. First image displays frontal digital scout image that shows patient rotated 8° in one direction. Parts of table top and roller devices that permit rotation also are seen.

 

Figure 3
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  		Fig. 2B —Images illustrating CT data acquired for calculation of vertebral rotation. Second image shows typical CT image obtained with rotation to left.

 

Figure 4
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  		Fig. 2C —Images illustrating CT data acquired for calculation of vertebral rotation. show two images, which have been cropped, obtained with left and right rotation. Software program rotates image D with respect to C to obtain best superimposition and then reports amount of rotation required to achieve that superimposition.

 

Figure 5
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  		Fig. 2D —Images illustrating CT data acquired for calculation of vertebral rotation. show two images, which have been cropped, obtained with left and right rotation. Software program rotates image D with respect to C to obtain best superimposition and then reports amount of rotation required to achieve that superimposition.

 

Figure 6
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  		Fig. 3A —MR images of spine showing technique for obtaining rotation measurements. Images were acquired with clockwise and counterclockwise rotations, respectively, collimated to a 30-pixel radius.

 

Figure 7
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  		Fig. 3B —MR images of spine showing technique for obtaining rotation measurements. Images were acquired with clockwise and counterclockwise rotations, respectively, collimated to a 30-pixel radius.

 

Figure 8
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  		Fig. 3C —MR images of spine showing technique for obtaining rotation measurements. Image results from superimposing A and B to show poor alignment (C).

 

Figure 9
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  		Fig. 3D —MR images of spine showing technique for obtaining rotation measurements. One image in C is then rotated with respect to other by means of a pixel-shifting method to minimize misalignment and amount of rotation required is recorded.

 

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