Estimating lumbar spine foraminal disc measurements using ultrasound and X-ray imaging through advanced image annotation, processing, and mathematical modeling during chiropractic traction procedures: A feasibility study

Why This Matters

Lumbar spine imaging is typically static, which limits the ability to observe how spinal dimensions change while a mechanical procedure is being applied. Ultrasound offers real-time imaging, but differences between ultrasound and X-ray measurements make direct comparison difficult.

This feasibility study explored a method for aligning measurements from X-ray and ultrasound so lumbar foraminal and disc-related dimensions could be estimated before and during graded chiropractic traction. The approach may provide a framework for studying real-time mechanical changes in the lumbar spine without relying solely on static imaging.

Importantly, this was a proof-of-concept study in healthy adults without a history of low back pain. It demonstrates measurement feasibility and biomechanical behavior, not diagnostic accuracy or treatment effectiveness in symptomatic patients.

What the Research Found

Fifteen healthy adults—8 men and 7 women—underwent a standardized chiropractic traction protocol. X-rays were obtained before the procedure, while ultrasound measurements were collected both before and during traction at L3-L4, L4-L5, and L5-S1.

Traction was progressively applied at 1.8 kg, 3.6 kg, 5.4 kg, and 11.3 kg. The researchers used geometric scaling and extrapolation methods to help reconcile measurements obtained from the two imaging modalities.

KEY POINTS

• Lumbar spinal measurements increased during progressive traction. Measures including height and area showed consistent increases as traction force increased, demonstrating measurable elongation under loading.
• Changes were evaluated across multiple lower lumbar levels. Ultrasound measurements were obtained at L3-L4, L4-L5, and L5-S1 before and during the traction procedure.
• The method combined static and real-time imaging information. Pre-procedure X-ray measurements were integrated with ultrasound measurements obtained during traction using scaling and extrapolation techniques.
• Real-time ultrasound captured mechanical changes during the procedure. The approach allowed spinal dimensions to be assessed while graded traction forces were actively applied.
• The findings establish feasibility rather than clinical effectiveness. All 15 participants were healthy and had no history of low back pain, so the results cannot establish diagnostic or therapeutic benefit in patients with lumbar disorders.