I was just asked to provide a testimonial for our first and only, to date, upright MRI clinic in Canada. And in writing it, thought I would provide a quick note on its value to me as a practitioner.
Very often, pain presents in a loaded state. That is, most of our patients complain of pain while sitting, after sitting, after standing, after bending, after lifting….etc.. you get the point. And it would hard pressed to find someone that disagrees with this. So, then, why are we imaging these patients while recumbent often when their pain is diminished to absent? Upright MRI allows a look into the dynamic nature of the intervertebral discs. And with the disc being the most popular pain generator for low back pain, why don’t we image the disc under load more frequently? Personally, I have used upright MRI to see the disc bulge even more in extension and reveal many spondylolistheses that are otherwise unrecognized. We do know in extension the disc will bulge more into the spinal canal and that is something that has been seen clearly. We also see this canal narrow as the ligamentum flavum folds anteriorly. (see the review of : Upright positional MRI of the lumbar spine Figure 1). This makes perfect sense why those stenotic patients, for example, find more relief with sitting. But what research cannot show, yet, is the innervation patterns in the annulus and the nucleus as it pushes through these tears under flexion.
ddd models can connect your knowledge of pain generators to a patient’s understanding. When there is understanding there is often better awareness and avoidance of aggravating spinal motions to help improve outcomes. I hope we continue to push in research directions to give us better tools to identify the pain generators and what to do about it clinically. Our patients deserve the best. JF