Upright weight-bearing Spine

The Medserena Signature Cervical spine examination and Signature Lumbar spine examination will always comprise seated sagittal images in neutral, flexion & extension together with coronal, either T2 or fat suppressed images, as well as axial images of the cervical or lumbar discs in the neutral position.

The value of imaging the spine in the upright position is that it not only shows the spine under the natural load of gravity, but also enables images to be made with the spine both flexed and extended.

The inclusion of flexion & extension ensures that any soft tissue abnormality causing pain is not overlooked, especially narrowing of the spinal canal by degeneration of the ligamentum flavum, fluctuating facet joint cysts or intervertebral discs that alter their degree of prolapse in either flexion or extension.

Scans in flexion & extension are the only method of showing the degree of spinal instability if it is present. This can avoid missing spinal instability that can occur for example, after some types of spinal fusion.

Intradiscal pressure for different body positions, normalized to an upright position (100%).
Test person 70 kg, 168 cm, 45 years old.
A.L. Nechemson, Spine 1, #1, pp. 59-71, 1976; H-J. Wilke, P. Neef, M. Caimi, T. Hoogland and L.E. Claes, Spine 24, #8, pp. 755-762, 1999

Upright MRI scans can be performed in an upright position and therefore natural weight-bearing position.

The spine can therefore be examined under real conditions. Pressure on the discs in particular is 11 times greater in the forward leaning seated position compared to the supine position. Weight-bearing disorders can be clearly identified with Upright MRI.

Furthermore, functional examinations can also be performed with flexion, reclining or lateral movements using the upright approach. Movement-dependent conditions can therefore be identi ed with the MRI scan and diagnosed more accurately.

Cervical spine

In the case of chronic or recurrent pain as the initial examination or if previous attempts at diagnosis have proved unsuccessful.

Confirmation/exclusion of degenerative changes.

Confirmation and/or exclusion of increased segmental mobility (also known as segmental collapse or angular instability).

Existing retro- or anterolisthesis to rule out an anterior drawer component or con rm listhesis with loading. In the presence of disc protrusion and pain inconsistent with the extent of disc herniation.

In the case of position-dependent radicular symptoms. With multi-segmental spinal narrowing to establish the site of greatest narrowing in various positions.

In the case of unclear myelopathy to rule out or confirm compression of the cervical myelon in various positions including flexion and extension

In the case of unclear syringohydromyelia to rule out Chiari malformation type I.

Lumbar spine

In the case of recurrent or persistent lumbar pain, either as a primary diagnostic procedure or where previous conventional MRI has failed to identify the cause of symptoms.

The following conditions in particular can be diagnosed via Upright MRI with no need for any additional examinations:

Proof or exclusion of segmental instability in patients with degenerative changes or after recent trauma.

Exclusion of spondylolisthesis in patients with known retro- or anterolisthesis within the framework of a degenerative pseudo- spondylolisthesis or isthmic spondylolisthesis.

To diagnose the disease mechanism and extent of spinal narrowing, especially in the case of multi-segmental spinal stenoses, including localization of the region with maximum narrowing in various positions.

Position-dependent, neural foraminal narrowing due to occult neural foraminal narrowing in the supine position. In the case of “Failed Back Surgery Syndrome” (FBSS) to establish the causative disease mechanism with loading.

Spinal examinations in the case of marked scoliosis and kyphosis are also feasible, with accurate angle measurements.

Examinations of the bony pelvis including the sacrum and sacroiliac joints.