Positional changes in lumbar disc herniation during standing or lumbar extension: a cross-sectional weight-bearing MRI s
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MUSCULOSKELETAL
Positional changes in lumbar disc herniation during standing or lumbar extension: a cross-sectional weight-bearing MRI study Cecilie Lerche Nordberg 1,2 Bjarke Brandt Hansen 1
&
Mikael Boesen 2 & Gilles Ludger Fournier 3 & Henning Bliddal 1 & Philip Hansen 2 &
Received: 8 January 2020 / Revised: 30 April 2020 / Accepted: 31 July 2020 # European Society of Radiology 2020
Abstract Objectives To investigate biomechanical changes in lumbar disc herniations. Methods Patients with lumbar disc herniation verified on a 1.5–3-T magnetic resonance imaging (MRI) scanner were imaged in a weight-bearing 0.25-T MRI scanner in (1) standing position, (2) conventional supine position with relative lumbar flexion, and (3) supine position with a forced lumbar extension by adding a lumbar pillow. The L2-S1 lordosis angle, the disc cross-sectional area, the disc cross-sectional diameter, and the spinal canal cross-sectional diameter were measured for each position. Disc degeneration and nerve root compression were graded, and the pain intensity was reported during each scan position. Results Forty-three herniated discs in 37 patients (36.7 ± 11.9 years) were analyzed in each position. The L2-S1 lumbar angle increased in the standing position (mean difference [MD]: 5.61°, 95% confidence interval [95% CI]: 3.44 to 7.78) and with the lumbar pillow in the supine position (MD: 14.63°, 95% CI: 11.71 to 17.57), both compared with the conventional supine position. The herniated disc cross-sectional area and diameter increased during standing compared with during conventional supine position. No changes were found in the spinal canal cross-sectional diameter between positions. Higher nerve root compression grades for paracentral herniations were found during standing compared with during conventional supine position. This was neither found with a lumbar pillow nor for central herniations in any position compared with conventional supine. Conclusion Disc herniations displayed dynamic behavior with morphological changes in the standing position, leading to higher nerve root compression grades for paracentral herniated discs. Key Points • Lumbar herniated discs increased in size in the axial plane during standing. • Increased nerve root compression grades for paracentral herniated discs were found during standing. • Weight-bearing MRI may increase the diagnostic sensitivity of nerve root compression in lumbar disc herniations. Keywords Magnetic resonance imaging . Low back pain . Spine . Intervertebral disc displacement . Weight-bearing
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07132-w) contains supplementary material, which is available to authorized users. * Cecilie Lerche Nordberg [email protected] 1
Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, DK-2000 F Copenhagen, Denmark
2
Department of Radiology, Copenhagen University Hospital, Bispebjerg and Freder
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