In a recent paper published in Spine, researchers looked to try and correlate MRI findings and the severity of pain related to lumbar spinal stenosis.
What is Lumbar Spinal Stenosis?
This is a narrowing condition of the spinal canal. It is often related to degeneration which causes an encroachment to the delicate spinal nerves traveling up and down the spine. This can be due to an over growth of bony spurs from the facets because of the disc height loss, or it can be due to the thickening and folding of the ligamentum flavum. Other factors like osteophytes, disc bulge and/or a congenital narrowing can also contribute. To get a birds eye view of the condition, you can view this degenerative lumbar spinal stenosis model I have crafted below for Dynamic Disc Designs Corp.
To get a better dynamic look at stenosis, below is a video that shows how bending the spine model backwards will narrow the spinal canal. This is often reported as a symptom in those that suffer from leg(s) and back pain with prolonged walking. Patients often report they can only walk a certain distance and then have to sit down ‘to rest their legs’. Sitting and bending the spine forward opens the spinal canal which can be seen in the model video.
Lumbar Spinal Stenosis Research and MRI
In the paper noted above, researchers performed a literature search to correlate MRI findings and the related severity of a patient’s stenosis symptoms. They concluded that no solid correlation could be found between MRI results and the associated symptoms of lumbar spinal stenosis. However, they also stated that lumbar spinal stenosis is a dynamic and often vertical experience for patients with lumbar spinal stenosis and talked about how the there ” is a need for innovative “methods/techniques” to learn more about the causal relationship between radiological findings and the patients’ pain-related complaints ”
If you look carefully at the research, the MRI parameters they used were recumbent MRI parameters. In other words, lying down MRI imaging.
Would it not make more sense to image the spine in its symptomatic position when the patient is upright?
The advent of upright MRI as an imaging technology helps us be better at specifying upright pain generators. Lucky for me, we have an upright MRI in British Columbia that can help target a specific diagnosis for my patients for those that exhibit problems when vertical.
- Burgstaller JM1, Schüffler PJ, Buhmann JM, Andreisek G, Winklhofer S, Del Grande F, Mattle M, Brunner F, Karakoumis G, Steurer J, Held U; LSOS Study Group. Is There an Association Between Pain and Magnetic Resonance Imaging Parameters in Patients With Lumbar Spinal Stenosis? Spine (Phila Pa 1976). 2016 Sep;41(17):E1053-E1062. ↩