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.

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