Degenerative lumbar scoliosis: added value of coronal images to routine lumbar MRI for nerve root compromise

Objectives Radiating pain in degenerative scoliosis is primary indication for surgery. However, axial and sagittal MR images are limited for identifying nerve root compromise. Therefore, we aimed to assess the value of coronal images for evaluating nerve root compromise in degenerative scoliosis. Methods Forty-six patients (mean 70 years; range 41-91 years; 8 men) with degenerative scoliosis were enrolled. Coronal images were added to routine MRI. Two radiologists independently reviewed 350 nerve roots in two MRI sets: sagittal images alone (set 1) and coronal and sagittal images combined (set 2). The following features were evaluated: interpedicular height, lateral osteophyte, asymmetric bulging disc, lateral listhesis, anterolisthesis, axial rotation angle, facet arthrosis, ligamentum flavum thickening, and pseudoarticulation. Symptomatic levels were determined by transforaminal selective nerve root block. Results There were 80 symptomatic and 270 asymptomatic nerve roots. The sensitivity (86%) and accuracy (93%) of set 2 were significantly higher than set 1 (53% and 87%) for radiculopathy, while specificity was similar between two sets (set 1, 97%; set 2, 95%). The AUC was significantly different between two sets (set 1, 0.853; set 2, 0.942). The negative interpedicular height difference, longer lateral osteophyte, asymmetric bulging disc, lateral listhesis, negative axial rotation angle difference, and pseudoarticulation were associated with change of grades between set 1 and set 2. Conclusion Coronal images are helpful for diagnosing nerve root compromise in patients with degenerative scoliosis.