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Are MRI Scans A Good Clinical Tool To Diagnose Mechanical Factors For Low Back Pain?

Dougill, GM and Reeves, ND and Le Maitre, C and Andrews, K and Cooper, G (2017) Are MRI Scans A Good Clinical Tool To Diagnose Mechanical Factors For Low Back Pain? Medical Engineering and Physics. ISSN 1873-4030 (In Press)

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Abstract

Clinicians attempting to diagnose low back pain (LBP) may use medical imaging to identify mechanical initiators such as disc bulging, protrusion and herniation leading to nerve impingement or other structural concerns. However current understanding of spinal posture is based on studies conducted in the relaxed supine position and/or with loading limited to bodyweight. However, some patients only have lower back pain during activities of daily living where significant changes in spinal posture occur and loading increases beyond that typical of imaging tests conducted in supine positions. This study investigates the differences between MRI images obtained in supine and standing positions, with or without additional loading to determine mechanical initiators which may be missed in patients who present pain during activity but not when at rest. Lumbar lordotic curvature was investigated using MRI imaging in 10 asymptomatic male subjects in three conditions: supine, standing and standing plus 12kg additional load. A number of key changes were seen in lordotic curvature between positions, 12 kg loading in a standing position resulted in a 17-42% increase in lordotic angle in the L1/L2 through L4/L5 discs when compared with the standing position (p > 0.05) and up to 71% increase compared with relaxed supine position (p = 0.05). L5/S1 lordotic angle was 21% lower in the loaded group relative to the supine baseline (p = 0.05) but was unchanged relative to the standing position. Pelvic angle between the S1 vertebrae and the horizontal plane was not significantly altered by MRI position. These results suggest that clinicians should be aware that MRI scans taken in the supine position may not indicate mechanical factors which cause low back pain during activities of daily living. Further investigation is required to determine whether loaded MRI positions are able to differentiate between degenerative changes within asymptomatic and symptomatic patients.

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