Introduction: Lumbar back pain and lumbar radiculopathy are common medical diagnoses that cause extensive economic burden. Unfortunately, conventional supine MRI findings and clinical symptoms do not necessarily correlate in the lumbar spine. While supine, the lumbar lordosis is physiologically reduced with relief or reduction in pain. Moreover, nerve root compression may not be visible with MRI performed in a supine position. With upright imaging, disc pathologies or foraminal stenosis may become more salient, leading to potential nerve root compression that is not visible on supine images.
Methods: Seventeen adults (10 asymptomatic patients and 7 symptomatic patients) were selected. A 0.6 T upright MRI scanned each patient in the upright position. Parameters were obtained from the L2/3 level to L5/S1 level, including those pertaining to the foramen (cross sectional area, height, mid-disc width, width, thickness of ligamentum flavum), the disc (bulge, height), and lumbar alignment (lordosis angle, wedge angle, lumbosacral angle, lumbar spine length). Findings were compared via pair t tests between symptomatic patients and asymptomatic patients.
Results: Among foramen parameters, the foramen height was statistically larger at the L3/4 disc space for the symptomatic group; the thickness of the ligamentum flavum was statistically larger along all disc space levels in the symptomatic group. The foramen cross sectional area was statistically smaller at the L5/S1 level in the symptomatic group. Among disc parameters, the disc bulge was significantly larger at L4/5 and L5/S1 in the symptomatic group. There were no significant findings among the lumbar alignment parameters.
Conclusions: This supports the significance of ligamentum flavum hypertrophy as a component of these symptoms. Moreover, symptomatic patients have larger disc bulge and smaller foramen cross sectional area at the lower lumbar levels. Given these findings, upright MRI may be useful to evaluate and treat symptomatic patients.
Patient Care: This research contributes to the knowledge regarding upright MRI and highlights the potential benefits of the imaging modality to diagnose symptomatic patients. Improvement with diagnosis will improve patient education, patient management, and patient outcome.
Learning Objectives: 1) Understand the background on upright MRI
2) Understand the potential usefulness of upright MRI for diagnosing lumbar pathologies based on differences in various parameters seen between symptomatic patients and asymptomatic patients.
References: 1. Froud, R., et al., A systematic review and meta-synthesis of the impact of low back pain on people's lives. BMC Musculoskelet Disord, 2014. 15: p. 50.
2. Hahne, A.J., J.J. Ford, and J.M. McMeeken, Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review. Spine (Phila Pa 1976), 2010. 35(11): p. E488-504.
3. Hoy, D., et al., The Epidemiology of low back pain. Best Practice & Research Clinical Rheumatology, 2010. 24(6): p. 769-781.
4. Splendiani, A., et al., Occult neural foraminal stenosis caused by association between disc degeneration and facet joint osteoarthritis: demonstration with dedicated upright MRI system. Radiol Med, 2014. 119(3): p. 164-74.
5. Balague, F., et al., Non-specific low back pain. Lancet, 2012. 379(9814): p. 482-91.
6. Tarulli, A.W. and E.M. Raynor, Lumbosacral radiculopathy. Neurol Clin, 2007. 25(2): p. 387-405.
7. Hedberg, K., et al., Low back pain: an assessment using positional MRI and MDT. Man Ther, 2013. 18(2): p. 169-71.
8. Weishaupt, D., et al., Positional MR imaging of the lumbar spine: does it demonstrate nerve root compromise not visible at conventional MR imaging? Radiology, 2000. 215(1): p. 247-53.
9. Gilbert, J.W., et al., Lumbar stenosis rates in symptomatic patients using weight-bearing and recumbent magnetic resonance imaging. J Manipulative Physiol Ther, 2011. 34(8): p. 557-61.
10. Iwata, T., et al., In vivo measurement of lumbar foramen during axial loading using a compression device and computed tomography. J Spinal Disord Tech, 2013. 26(5): p. E177-82.
11. Schmid, M.R., et al., Changes in cross-sectional measurements of the spinal canal and intervertebral foramina as a function of body position: in vivo studies on an open-configuration MR system. AJR Am J Roentgenol, 1999. 172(4): p. 1095-102.
12. Zamani, A.A., et al., Functional MRI of the lumbar spine in erect position in a superconducting open-configuration MR system: preliminary results. J Magn Reson Imaging, 1998. 8(6): p. 1329-33.
13. Shymon, S.J., et al., Altered disc compression in children with idiopathic low back pain: an upright magnetic resonance imaging backpack study. Spine (Phila Pa 1976), 2014. 39(3): p. 243-8.
14. Shymon, S., et al., Body posture and backpack loading: an upright magnetic resonance imaging study of the adult lumbar spine. Eur Spine J, 2014. 23(7): p. 1407-13.
15. Tarantino, U., et al., Lumbar spine MRI in upright position for diagnosing acute and chronic low back pain: statistical analysis of morphological changes. J Orthop Traumatol, 2013. 14(1): p. 15-22.
16. Dabbs, V.M. and L.G. Dabbs, Correlation between disc height narrowing and low-back pain. Spine (Phila Pa 1976), 1990. 15(12): p. 1366-9.
17. Gilbert, J.W., et al., Lumbar disk protrusion rates of symptomatic patients using magnetic resonance imaging. J Manipulative Physiol Ther, 2010. 33(8): p. 626-9.
18. Zemp, R., W.R. Taylor, and S. Lorenzetti, In vivo spinal posture during upright and reclined sitting in an office chair. Biomed Res Int, 2013. 2013: p. 916045.
19. Rodriguez-Soto, A.E., et al., Effect of load carriage on lumbar spine kinematics. Spine (Phila Pa 1976), 2013. 38(13): p. E783-91.