Associations between Patient Report of Pain and Intervertebral Foramina Changes Visible on Axial-Loaded Lumbar Magnetic Resonance Imaging.

Tomasz Lorenc,Dariusz Syganiec,Wojciech M Glinkowski,Marek Gołębiowski

doi:10.3390/diagnostics12030563

Tomasz Lorenc, Dariusz Syganiec + Show 2 more

Open Access

https://doi.org/10.3390/diagnostics12030563

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Journal: Diagnostics	Publication Date: Feb 23, 2022
Citations: 1	License type: CC BY 4.0

Affiliation: Medical University of Warsaw

Abstract

The intervertebral foramen may influence spinal nerve roots and, therefore, be related to the corresponding dermatomal pain. In vivo evaluation of the intervertebral foramen–dermatome relationship is essential for understanding low back pain (LBP) pathophysiology. The study aimed to correlate the lumbar MRI unloaded-loaded foraminal area changes with dermatomal pain in the patient’s pain drawings. Dynamic changes of the dermatomal pain distribution related to the intervertebral foramen area changes between quantitative conventional supine MRI (unloaded MRI) and axial-loading MRI (alMRI) were analyzed. The MRI axial-loading intervertebral foramen area changes were observed, and the most significant effect of reducing the foraminal area (−6.9%) was reported at levels of L2–L3. The incidence of pain in the dermatomes increases linearly with the spine level, from 15.6% at L1 to 63.3% at L5 on the right and from 18.9% at L1 to 76.7% at L5 on the left. No statistically significant effect of changes in the intervertebral foramen area on the odds of pain along the respective dermatomes was confirmed. Changes in the foraminal area were observed between the unloaded and loaded phases, but differences in area changes between foramen assigned to painful dermatomes and foramen assigned to non-painful dermatomes were not significant.

Highlights

The differential diagnosis of low back pain includes a wide range of diagnoses that may result in irritation of the spinal nerve roots in the lower lumbar spine due to the pathology of the intervertebral foramen [1,2,3,4,5,6]
This study reports the relationship between dermatomal pain and changes in the foraminal area diagnosed by axial-loading magnetic resonance imaging of the lumbar spine
Singh et al [12] showed that the average percent decrease in the foraminal area was 30.0%, with the most significant decrease from flexion to extension occurring at L2–L3 (35.7%) and the minor change occurring at L5–S1(21.5%). It differs from the findings presented here, where we observed the most significant effect of reducing the foraminal area for both sides at the L2–L3 level, and it was 6.9%; and, in contrast to previous findings, the area of intervertebral foramen increased by 2.25–2.48% at the level of L5–S1 when exposed to axial loading

Summary

Introduction

The differential diagnosis of low back pain includes a wide range of diagnoses that may result in irritation of the spinal nerve roots in the lower lumbar spine due to the pathology of the intervertebral foramen [1,2,3,4,5,6]. Dermatomes are areas of the skin of the trunk and extremities innervated by the cutaneous branches of the dorsal and ventral branches of the spinal nerves [8,9,10]. Each of these nerves transmits sensations, including pain, from a specific skin area to the brain, where the right spinal root L1 passes through the right intervertebral foramen L1–L2 and delivers the right dermatome L1. The pathology of the L1–L2 intervertebral foramen may irritate the L1 spinal nerve and may be reflected in pain within the L1 dermatome, which applies to other spinal levels

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