title: Repeat upright positional magnetic resonance imaging for diagnosis of disorders underlying chronic noncancer lumbar pain.
abstract: OBJECTIVE
  Cases of chronic noncancer pain are both the most frequent and the most difficult that the spine care professional is called upon to treat. We use this case to illustrate the potential effectiveness of repeat positional upright, weight-bearing magnetic resonance (MR) imaging to diagnose disorders and to detect changes in disorders.
  
  
  METHODS
  We present the case of a 35-year-old man referred to our neurosurgical clinic with complaints of chronic, noncancer lower back pain and right-greater-than-left sciatica. Traditional recumbent MR imaging had revealed degenerative disk disease at L5-S1 and a 2.2-mm (grade 1) degenerative spondylolisthesis. The patient had not improved after more than a year of conservative treatments and, moreover, had been prescribed opiates for pain management that were potentially masking changes in his condition.
  
  
  RESULTS
  After referral to our clinic, we ordered repeat lumbar MR imaging in an upright weight-bearing position (sitting) 14 months after the patient's recumbent MR imaging. The weight-bearing MR imaging revealed a 9.13-mm (grade 1) degenerative spondylolisthesis at L5-S1. The patient underwent arthrodesis. His leg pain and back were significantly and clinically improved.
  
  
  CONCLUSIONS
  When patients with noncancer, lower back pain worsen, fail to improve, or require opiates to manage their pain, updated clinical diagnosis including repeat positional imaging may be an effective diagnostic strategy.
authors.affiliation: Spine and Brain Neurosurgical Center, Lexington, Kentucky 40503, USA. j.hower@insightbb.com
authors.forename: John W
authors.initials: JW
authors.lastname: Gilbert
authors.forename: Greg R
authors.initials: GR
authors.lastname: Wheeler
authors.forename: Martin P
authors.initials: MP
authors.lastname: Kreft
authors.forename: Shailesh P
authors.initials: SP
authors.lastname: Upadhyay
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Storey
authors.forename: John R
authors.initials: JR
authors.lastname: Spitalieri
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Mick
authors.forename: Richard A
authors.initials: RA
authors.lastname: Gibbs
mesh_terms: D000328:Adult; D015984:Causality; D002684:Chiropractic / Q000379:methods*; D002908:Chronic Disease; D015299:Discitis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010808:Physical Examination; D011187:Posture; D012447:Sacrum; D012585:Sciatica / Q000175:diagnosis / Q000209:etiology; D013123:Spinal Fusion; D013168:Spondylolisthesis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D017211:Treatment Failure; D016474:Weight-Bearing