title: Upright magnetic resonance imaging of the lumbar spine: Back pain and radiculopathy.
abstract: BACKGROUND
  Lumbar back pain and radiculopathy are common diagnoses. Unfortunately, conventional magnetic resonance imaging (MRI) findings and clinical symptoms do not necessarily correlate in the lumbar spine. With upright imaging, disc pathologies or foraminal stenosis may become more salient, leading to improvements in diagnosis.
  
  
  METHODS
  Seventeen adults (10 asymptomatic and 7 symptomatic volunteers) provided their informed consent and participated in the study. A 0.6T upright MRI scan was performed on each adult in the seated position. Parameters were obtained from the L2/3 level to the L5/S1 level including those pertaining to the foramen [cross-sectional area (CSA), height, mid-disc width, width, thickness of ligamentum flavum], disc (bulge, height, width), vertebral body (height and width), and alignment (lordosis angle, wedge angle, lumbosacral angle). Each parameter was compared based on the spinal level and volunteer group using two-factor analysis of variance (ANOVA). Bonferroni post hoc analysis was used to assess the differences between individual spinal levels.
  
  
  RESULTS
  Mid-disc width accounted for 56% of maximum foramen width in symptomatic volunteers and over 63% in asymptomatic volunteers. Disc bulge was 48% greater in symptomatic volunteers compared to asymptomatic volunteers. CSA was generally smaller in symptomatic volunteers compared to asymptomatic volunteers, particularly at the L4-L5 and L5-S1 spinal levels. Thickness of ligamentum flavum (TLF) generally increased from the cranial to caudal spinal levels where the L4-L5 and L5-S1 spinal levels were significantly thicker than the L1-L2 spinal level.
  
  
  CONCLUSIONS
  The data implied that upright MRI could be a useful diagnostic option, as it can delineate pertinent differences between symptomatic volunteers and asymptomatic volunteers, especially with respect to foraminal geometry.
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Wisconsin, USA.
authors.forename: Ha Son
authors.initials: HS
authors.lastname: Nguyen
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Wisconsin, USA.
authors.forename: Ninh
authors.initials: N
authors.lastname: Doan
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Wisconsin, USA.
authors.forename: Saman
authors.initials: S
authors.lastname: Shabani
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Wisconsin, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Baisden
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Wisconsin, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wolfla
authors.affiliation: Naval Air Warfare Center, Aircraft Division, Patuxent River, Maryland, USA.
authors.forename: Glenn
authors.initials: G
authors.lastname: Paskoff
authors.affiliation: Naval Air Warfare Center, Aircraft Division, Patuxent River, Maryland, USA.
authors.forename: Barry
authors.initials: B
authors.lastname: Shender
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Wisconsin, USA; Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Stemper
keywords: Foraminal stenosis; lumbar back pain; lumbar radiculopathy; magnetic resonance imaging (MRI); upright MRI