DIAGNOSING BACK PAIN 1

Diagnosing Back Pain

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DIAGNOSING BACK PAIN 2

ABSTRACT

Over time, back pain has become prevalent in society, hindering many people from being active

in their economic and social surroundings. Furthermore, lower back pains (LBP) have been

widespread, depicting an estimated occurrence of between 60% and 90%. Therefore, an

estimated 80% of people will experience LBP at a given point in their lifetime (. Magnetic

Resonance Imaging represents one of the most applied diagnostic tools of LBP. Notably, lower

back pain can result from a number of causes, including stenosis, disc herniation, degenerative

disc, facet joint dysfunction, among others. During the application of MRI, the position of

patients is crucial in the diagnosis (Shaikh et al., 2020). For instance, traditional MRI of the spine

would require lying flat while FONAR upright multi-position scanners involve several

diagnostic positions such as sitting or bending. The paper will describe how traditional MRI

scanners differ from upright multi-position scanners in their functionality and diagnostic results,

providing vital information for future investigations on LBP diagnostic procedures.

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CHAPTER 1: INTRODUCTION

Over the years, society has been subjected to lumbar radiculopathy and lower back pain,

posing significant economic burdens in the medical and social fields. Lower back pains mainly

result from soft tissue and mechanical injuries. Besides, injuries can lead to nerve roots' solidity,

harm to the intervertebral discs, and inappropriate spinal joints movements. Notably, pulled or

torn ligament or muscle depict the predominant cause of Lower back pain. Medical treatment's

primary goal is to decrease pain instead of altering the primary source of discomfort. Moreover,

lower back pains have been widespread, depicting an estimated prevalence of between 60% and

90% (Splendiani et al., 2016). Meaning more than one-tenth of the total population nay at some

point in their life become disabled. Due to lower back pains' scalability, the health care systems

are predominantly faced with insufficient discontent and recoveries rates. Notably, accessing the

pain targeting the primary source involves supine magnetic resonance imaging (MRI) (Hansen,

2017). The paper will explore traditional MRI scanners and upright multi-position scanners,

some of the differences in their functionality, and how that affects diagnosis outcomes.
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CHAPTER 2: LITERATURE REVIEW

The Magnetic Resonance Imaging scan represents a diagnostic study option designed by

physicians to help in reaching pain from back pain. MRI study resulted from a concise review of

organs and tissue images through the body using computer software, radio waves, and solid

magnetic elements. Traditional MRI scans involved patients lying on their back on a flat surface;

moreover, the patients had to bend their hips and knees into a hollow tube. Despite these MRI

scanners' ability to diagnose several conditions, they still fall short and overlook particular

abnormalities due to the spine not being in the appropriate position during the checkup (Sato et

al., 2016). For this reason, a new stand-up model was established in 1996 by Fonar to help

minimize traditional MRI scanners. Notably, the excellent multi-position MRI scanner brought

many advantages and significant strides in the medical field. The new model allows patients to

be flexible by varying weight-bearing positions such as lying down, sitting, bending, or standing

(Rustagi et al.,2020). Therefore, the flexibility enables the pains to be in the situation causing the

pain, thus reducing the margin of errors characterized as misdiagnosis. Due to the advanced

nature of the FONAR upright multi-position, nearly 155 have been installed worldwide since its

inception.

Notably, the new model's primary goal is to bring new and advanced methods of handling

back pain, prevalent in recent years. The two main classifications of back pains involve acute

and chronic. Besides, most individuals encounter pain at the lower point of their backs that

mainly support the upper body weight (Wagner et al., 2016). Several causes result in chronic

lower back pain. Notably, the back pain felt at the lower back regularly involves irritated nerve

roots, joint, and disc problems. More importantly, common causes of chronic lower pains

include;
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 Degenerative disc disease- Notably, the intervertebral disc contains adequate water,

which is at birth when an individual is at the healthiest. However, over the years, as the

individual ages, the disc undergoes hydration which causes the disc to wear down. Therefore, the

disc weakens the hydration, and they're for transfers the pain to the disc wall since it has no

power to resist forces (Abu-Naser & ALDAHDOOH, 2016). For this reason, a person can

collapse or contribute to stenosis leading to discomfort or fading, which can cause a herniation.

 Lumbar herniated disc involves breakage of the lumbar disc tough outer layer, a jelly-like

center, irritating a nerve root nearby. Notably, the herniated region on the disc contains a lot of

protein that causes inflames of a nerve root, which leads to compressions that lead to nerve root

pains. Besides, a rich supply of fibers can cause wall tears causing severe pain.

 Facet joint dysfunction- Each disc comprises of two facet joints positioned behind the

disc and lumbar spine at the motion part. Also, between the bones of joints contains cartilage

enclosed in a capsular ligament richly innervated into nerves (Svanbergsson, Ingvarsson &

Arnardottir, 2017). Therefore, pain can be caused by the joints themselves or in combination

with disc pain.

 Spinal stenosis- This condition causes pain by narrowing the spinal canal the location of

several nerve roots. Notably, the narrowing process can occur at the foraminal, central, and or

both. Besides, the narrowing can be on a repetitive level or single level at the lower back that

may cause pain.

 A compression fracture can be described as a fracture in the cylindrical vertebra where

the bone hollows in itself, initiating pain in the process. Notably, this condition is common in

older people since they have weak bones, for instance, osteoporosis.
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 The deformity can be described as curving of the spine leading to a deformity that may

include kyphosis or scoliosis ((Abu-Naser & ALDAHDOOH, 2016). Notably, the deformity is

described as a source of lower back pain (LBP) if it results in the collapse of the facet joints,

stenosis, sacroiliac, and discs.

It is imperative to note that the existence of one or more of these conditions may not be

the precise cause of lower back pain. Besides, illnesses such as degenerative disc or osteoarthritis

could be observed on an imaging examination; however, the patient may not report pain.

Therefore, vertical multi-position movement is the more proper Magnetic Resonance Imaging

scanner for its precision, particularly on the vertebral column (Wagner et al., 2016). Notably,

researchers continue to explore the lumbar spine to ascertain whether application of the uptight

imaging of foraminal stenosis or pathologies result in better diagnosis. Notably, the study

revealed that more research should be done on lumbar lordosis (Rustagi et al.,2020. Moreover,

lumbar lordosis is enlarged or reduced with variation in movements from a prone position to

standing within individuals. Placing the body at the natural weight-bearing position reduced

more minor curvatures and enlarged larger curvatures.

Notably, recent research was conducted to determine the benefits of using good MRI

scanners when examining the vertebral column. However, it is essential to note that there are still

uncertainties in the specific pathologies gotten from upright machines and those that aren't.

Moreover, comparing upright multi-position scanners and traditional MRIs has some challenges,

such as limited cervical and thoracic spine data. Most research involves information concerning

supine and standing MRIs without details about extension and flexion (Guglielmi & Boesen,

2019). Therefore, focusing on the Vertebral column pathologies comprising radiculopathy,

lumbar lordosis as well as other regions within the thoracic, lumbar, and cervical provides the
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basis for comparing upright multi-position and the traditional magnetic resonance imaging

scanners.
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CHAPTER 3: METHODOLOGY

The research's primary process involves evaluating proper multi-position functionality

compared with the traditional passive Magnetic Resonance Imaging scanners to identify the most

beneficial examining pain in the vertebral column. Notably, the experiments involve patient

examination of the upright and supine position. Positional fluctuations in investigation result

from back pain association with adjustment in the movement and alignment of the lumbar spine.

It is imperative to research how the extent of lumbar segmental degeneration affecting variations

in the lumbar spine that result from switching from the supine to the load-bearing sitting position

(Abu-Naser & ALDAHDOOH, 2016). The study involves twenty patients with chronic low back

pain comprising ten males and 12 females; average age 42 years. The patients' lumbar spine was

initially measured by the traditional supine magnetic resonance imaging rather than positional

MRI in the sitting position.

Positional MRI Variations in Horizontal Versus Sitting Postures

Notably, out of the 1200 discs examined, 72 patients were placed on the healthy grade I,

grade 2 recorded 17, grade 3 recorded 28, and 13 for grade 4. The results of the procedure

indicated that the end-plates angles reduced substantially as the degeneration was enlarged. The

results were emanating from the loader lumbar spine shift from the horizontal to the sitting

posture. In addition, the procedure showed adjustments in the middle and interior disc heights

due to fluctuations in the flat and sitting position regardless of the extent of degeneration.

Therefore, there were minimum variations involved in the lumbar lordosis between the two

examination positions. Moreover, the findings determined that fluctuations in the segmental

motion were associated with the extent of degeneration (Wagner et al., 2016). Notably, the

positional MRI initiated by upright magnetic resonance imaging scanners revealed variations in
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the degenerative discs and healthy load-bearing positions. Therefore, upright MPI scanners

benefit more in trying to understand the composite kinematics of the lumbar spine.

It is also significant to include research on other positions apart from these primary

positions. The FONAR upright multi-position MRI can allow other functions that the patients

agree to cause the most pain. Florida will provide the most suitable participants for the project

since conventional MRI apparatuses and FONAR proper multi-positional equipment are found in

several locations such as Naples, Boca Raton, and Orlando (Weber et al., 2019). An orthopedic

physician will screen the patients after consulting with the participants and sharing essential

information regarding the study and the underlying pathologies. Screening procedures will be

conducted before accessing the magnetic resonance imaging surrounding. Besides, participants

will be required to sign an Institutional Review Board that offers an approved consent at the MRI

location (Lao et al., 2014). More importantly, the IRB-approved consent form includes the

purpose of the research and potential risks involved during procedures allowing participants the

freedom to pull out from the study.

Impacts of Upright on Intervertebral Disc Geometry Lumbar Spine Alignment

Notably, most diagnostic imaging occurs in the horizontal which unloaded position.

Nevertheless, there is limited information on how healthy spines adapt to the standing posture

that involves functional loading that alters the intervertebral disc geometry and the spinal

alignment. Moreover, the study seeks to establish variations of the lumbar spine in standing and

flat positions in back-health young people using a positional MRI system such as FONAR multi-

position MRI scanners (Guglielmi & Boesen, 2019). The procedure involves an examination of

fluctuations in the intervertebral disc geometry and lumbar spine. Moreover, 16 males and 18

females with no back pain history will examine the standing and flat positions. The sagittal Cobb
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angle will be used to explore the regional lumbar spinal alignment. At the same time, the

segmental intervertebral disc will be examined at an internal to subsequent height ratio, the width

of the intervertebral disc studied at L1/L2 -L5/L6 levels. Also, it is essential to conduct an intra-

class correlation for inter and intra-observer measurements.

The procedures' findings depicted a range of 0.76 to 0.98 model range on the intra-

observer intra-class association while a 0.68 to 0.69 range related to the inter-observer

association. Participants in the standing position show reduction in the Cobb angle and

Segmental Cobb angle (Weber et al., 2019). Still, in the same position, an increase in the internal

to subsequent height ratios and decreased anterior to posterior height ratios were observed.

Notably, the widths of intervertebral widths did not show any variation in flat to standing

positions. The study determined better diagnosis results using positional magnetic resonance

imaging system through back-health population participants (Lao et al., 2014). This normative

information can inform future investigations that examine the lumbar spine's positional

variations, particularly to persons with intervertebral or spinal disc pathologies.

In conclusion, most studies have revealed that upright magnetic resonance imaging

provides better outcomes in examining patients with back pain. Research involving the lumbar

spine to ascertain whether upright examination of foraminal stenosis or disc pathologies can

offer better diagnosis determined that more studies should extend to the lumbar lordosis. Upright

multi-position magnetic resonance imaging provides MRI apparatus advancements, allowing

people to be examined on positions that cause them pain. Therefore, it presents the medical field

with some significant benefits to both physicians and patients. Upright MRI allows individuals to

be examined in the multi positions such as horizontal, bending, standing, and sitting. Therefore,

the system reduces the potential margin of error experienced more often with the traditional MRI
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scanners. There are around 150 FONAR upright MRI scanners installed globally, depicting the

progressive nature of the machine. More importantly, back pain one of the significant causes of

disability, particularly among elderly patients; finding the best diagnostic option is fundamental.
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