Structural Remodeling of the Lumbar Spine Following Non-Surgical Spinal Decompression: An Automated MRI Study

Background and Objectives: To investigate MRI changes using SpineReport (r20260928) following non-surgical spinal decompression (NSSD) in patients with chronic low back pain (cLBP). We conducted a retrospective review of patients treated with NSSD who obtained MRI within 6 months of treatment initiation. Methods: Thirty-six subjects (20 F, 16 M), with a mean age of 55.9 ± 16.4 years, were treated at the USF Health Chiropractic Clinic, Department of Neurosurgery, Brain & Spine. NSSD using DRX9000^® (Excite Medical, Tampa, FL, USA) was utilized, with a median of 20 (20, 25) treatments. Treatment levels included L3 (n = 2), L4 (n = 18), and L5 (n = 16). Sagittal T2-weighted images were processed using TotalSpineSeg (r20251124) for automated segmentation, with SpineReport used to quantify disc, vertebrae, spinal canal, and intervertebral foramen metrics. Results: Mean pain scores improved by 3.4 ± 1.8 from 5.6 ± 1.6 (p < 0.001), while Oswestry Disability Index scores improved by 10.8 ± 9.1 from 17.3 ± 8.0 (p < 0.001). At the treated level, spinal canal cross-sectional area increased from 170.9 to 175.8 mm² (2.9%, p = 0.040), and right-left diameter increased from 16.0 to 16.3 mm (1.9%, p = 0.025). Disc volume decreased from 7762.8 to 7449.5 mm³ (-4.0%, p = 0.046). No significant changes were observed in disc thickness, DHI, intervertebral foramen area, or vertebral measurements (p > 0.05). Conclusions: SpineReport enabled automated quantification of key spinal structures. NSSD was associated with increased spinal canal dimensions and improved symptoms. Further research is needed to determine the persistence and clinical significance of these structural changes.