Impact of T2-Weighted Whole-Spine Sagittal MRI Sequences on Diagnostic and Patient Care Trajectories: An Illustrative Case Series

Abstract

Background: T2-weighted whole-spine sagittal MRI (WSSMRI) sequences provide a rapid, comprehensive assessment of the neuroaxis and can reveal pathology beyond the symptomatic region. Despite minimal additional acquisition time, these sequences remain underutilized in specialist practice.

Research question: How are WSSMRI sequences used clinically to alter diagnostic and surgical decision-making?

Material and methods: Three non-consecutive, purposively selected patients assessed in an orthopaedic spine center for thoracolumbar complaints are presented. All patients underwent dedicated thoracolumbar MRI for their primary complaint, supplemented with T2-weighted WSSMRI sequences acquired on a Siemens Magnetom Lumina 3T scanner using digitally stitched cervicothoracic and thoracolumbar sagittal sequences, with 90 seconds image acquisition. Clinical information, imaging findings, and downstream management decisions were drawn from medical records with signed informed consent.

Results: In the first case, a 69-year-old male referred for lumbar radiculopathy was found to have concurrent cervical cord compression with myelomalacia, leading to surgical sequencing that prioritized cervical decompression ahead of lumbar intervention. The second case, a 52-year-old female with low back pain, revealed Chiari malformation type 1.5 with syringomyelia, prompting neurosurgical referral and ongoing clinical and radiological surveillance despite initial symptoms being attributed to lumbar pathology. The third case, a 48-year-old female with chronic post-traumatic axial thoracolumbar pain, demonstrated multilevel occult vertebral compression fractures on WSSMRI, which led to investigation and initiation of multidisciplinary osteoporosis management. In each instance, WSSMRI sequences identified pathology outside the symptomatic region and directly influenced care trajectories.

Discussion and conclusion: T2-weighted WSSMRI is a rapid, low-burden adjunct to routine thoracolumbar imaging that can uncover clinically significant findings and alter management. While its broader integration into practice offers clear benefits, challenges regarding incidental findings and downstream costs warrant further consideration.