Upright versus recumbent lumbar spine MRI: Do findings differ systematically, and which correlates better with pain? A systematic review

Klaus Doktor ¹, Henrik Wulff Christensen ², Tue Secher Jensen ³

⁰Center for Muscle and Joint Health, Department of Sport Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark; Diagnostic Center-Imaging Section and University Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Denmark.

The Spine Journal : Official Journal of the North American Spine Society +

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January 25, 2025

View abstract on PubMed

Summary

Upright MRI shows systematic differences in measurements compared to recumbent MRI for low back pain (LBP) patients. While upright scans may better correlate with pain, more research is needed to confirm clinical significance.

Area Of Science

Radiology and Medical Imaging
Orthopedics
Spine Health

Background

Recumbent MRI is standard for low back pain (LBP), but upright (standing) MRI may offer advantages by assessing weight-bearing effects.
Hypotheses suggest upright MRI reveals systematic differences in parameters and correlations with pain/disability.

Purpose Of The Study

To systematically review and summarize empirical evidence supporting or refuting the hypotheses regarding upright vs. recumbent MRI in LBP.

Main Methods

Systematic literature review (PROSPERO ID: CRD42017048318) of studies with paired upright and recumbent MRI observations.
Included studies required a minimum of 15 participants (aged 18+) with or without LBP/radiculopathy.
Analyzed continuous, ordinal, and dichotomous MRI parameters, comparing observed differences to prespecified expectations and assessing correlations with pain/disability.

Main Results

Nineteen studies (5,082 participants) were analyzed, examining numerous MRI parameters.
Observed differences between recumbent and upright MRI generally aligned with expectations due to weight-bearing.
Limited studies reported correlations with pain/disability, but upright MRI showed potentially higher correlations.

Conclusions

Systematic differences exist between recumbent and upright MRI parameters, supporting the weight-bearing hypothesis.
Upright MRI may enhance correlation with pain, but definitive evidence and clinical significance require further investigation.
Direct research on upright MRI's impact on clinical decisions and patient outcomes is needed.

Keywords:

Diagnostic findings Low back pain Lumbar spine Prevalence Upright MRI Weight-bearing MRI