The interview below was first published in Argos Spine News in December 2006. As part of our sponsorship of Argos, we'll be bringing a series of Argos content to our audience throughout the year. In this entry, Dr. Jean-Pierre Elsig discusses his history as a spine surgeon and the emergence of FMRI as a diagnostic tool.
Interview by Anca Mitulescu
Dr. Elsig, could you please give our readers an overview of your career in spine surgery? How did you chose this speciality? Who were your mentors? What were the main landmarks on your path?
I became interested in this challenging and developing subspeciality while completing my orthopedic residency. My mentors were Prof. A. Narakas in Lausanne, Profs. A.Schreiber and Y. Suezawa at the Balgrist University Clinic in Zurich, Profs. R. Louis from Marseille and R. Roy-Camille from Paris. I also visited and learned from the faculty of many different centers in Europe and the USA.
I soon realized that while spinal imaging studies were essential for planning surgical treatment, there was often an insufficient correlation between the patient's complaints, the radiographic images and reports, and the intraoperative findings. A long interdisciplinary collaboration with various specialists helped me to advance step by step. I was the partner and the successor of Prof. Suezawa. In 1994 I began my own orthopaedic practice, and since 2005 I have also worked for the "FMRI Zentrum" in Zurich.
How do you define dynamic versus static spinal stenosis?
Dynamic stenosis is detected at an earlier stage of the disease process, when patients complain of position and activity-related symptoms. In this stage positioning and kinematic changes cause stenosis. At later stages of degeneration, the motion segment loses mobility mostly due to hypertrophic bone and soft tissue reaction (including calcification and reactive ossification). At this point there are fewer or no position-related changes.
What are the traditional means of investigation to diagnose spinal stenosis?
In the past we used functional myelogram followed by post-myelographic CT Scan or recumbent MRI with conventional dynamic radiographs. Now with [Functional MRI], we can image the spine in the axial, sagittal and coronal planes, in a standing or seated position, with lateral bending or rotation, and if needed also with the patient recumbent.
What does the FMRI bring to the diagnosis and assessment of spinal stenosis?
FMRI allows non-invasive detection of dynamic changes that occur with weight bearing and positional changes. Residual post-surgical instability after decompression of spinal stenosis is at risk to further decompensate, leading to poor postoperative results that have been called "failed back syndrome." The dynamic changes under weight bearing conditions include foraminal narrowing and a reduction in disc height. Myelogram and CT myelogram are poor studies for evaluating foraminal pathology, especially in the sagittal plane.
Apart from spinal stenosis, what are the other applications of FMRI in the assessment of spinal disorders? What other spinal pathology could be more specifically diagnosed with FMRI?
Mobile disc herniations, spondylolisthesis, posttraumatic instability, and particularly the postoperative spine are well evaluated with FMRI. The main indications are combined pathologies, where dysfunctional intersegmental motion is associated with disc herniation and spinal canal and/or foraminal narrowing. The assessment of fusion, adjacent segment degeneration, and the function or failure of some dynamic implants are also appropriate indications for FMRI. FMRI could also allow a radiation free follow-up of children and young patients with scoliosis.
What are the applications of FMRI for other joints or organ systems?
All load and position dependent pathologies may be studied with FMRI. This includes not only both other orthopaedic pathologies such as lateral subluxation of a meniscus and the compression of a Morton neuroma while standing, but also gynaecologic and urologic pathologies. Finally, FMRI is a valuable tool for claustrophobic patients. It has sufficient sensitivity to detecpathology for any MRI study, including brain and vascular imaging. As research tool, FMRI has a huge potential not only in sports medicine and physiology, but also in actuarial science.
Dr. Jean-Pierre Elsig was elected President of the next Argos international symposium in 2007. His research encompasses the 3D reconstruction of spinal deformity and instability in congenital, degenerative, postsurgical and posttraumatic pathology, including their spinal restabilization and clinical outcome. His efforts in improving the correlation between clinical and radiolographic studies led to the creation of a center for positional and kinetic (i.e., "functional MRI") imaging of the spine in Zurich (www.fmri.ch), using the first dedicated upright, weight-bearing, dynamic-kinetic MRI unit. Dr. Elsig is a graduate of the medical school in Lausanne and since 1994 has worked in private practice in Zurich and operated at variety of hospitals.
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