Differences in lumbar spine measures as a function of MRI posture in low back pain patients and its clinical implications

Abstract

Study Design

Observational Study

Objective

The primary objective was to determine if there were differences in spine structure measures between experimental postures and standard supine posture MRIs.

Methods

Thirty-four low back pain patients were included. MRI was taken in 6 experimental postures. The dependent measures includes sagittal view anterior (ADH), middle and posterior disc heights, thecal sac width, left/right foraminal height (FH). In the axial view: disc width, left and right foraminal height. Measures were done L3/L4, L4/L5 and L5/S1. Each subject served as their own control. Spine measurements in the experimental posture were compared to the same measures in the standard supine posture.

Results

94% inter-observer reliability was seen. In the sagittal and axial view, 55 of the 108 and 11 of the 18 measures were significantly different. In sagittal view: a) ADH was significantly smaller in the sitting flexed posture by 2.50 mm ± 0.63 compared to the supine posture; b) ADH in sitting neutral posture was significantly smaller than the standard posture by 1.97 mm ± 0.86; c) sitting flexed posture showed that bilateral FH measures were significantly different; d) Bilateral FH was larger in the sitting neutral posture compared to the standard supine posture by 0.87 mm ± 0.17.

Conclusions

This research quantifies the differences in spine structure measures that occur in various experimental postures. The additional information gathered from an upright MRI may correlate with symptoms leading to an accurate diagnosis and assist in future spine research.

Keywords:

• Low back pain
• positional MRI
• transforaminal
• foraminoplasty
• ligamentum flavum

Disclosure statement

The authors report no conflict of interest.