Previous studies have investigated the inter-rater reliability of supine MRI findings of the lumbar spine and identified significant variability across degenerative conditions and raters. There are no systematic and critical reviews that have evaluated these issues, but three recent narrative reviews have argued for the value of upright MRI. However, upright MRI may also be associated with lower sensitivity to serious findings, due to increased motion artifact, and lower image quality. There is evidence that upright MRI improves the correlation between image findings and patient symptoms beyond supine MRI. It has been suggested that conventional supine MRI may underestimate the presence and degree of gravity-dependent degenerative spinal pathology due to the dynamic nature of some degenerative entities such as disc herniation and scoliosis.
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