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Positional changes in lumbar disc herniation during standing or lumbar extension: a cross-sectional weight-bearing MRI study

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.

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Abbreviations

CI:

Confidence interval

FOV:

Field-of-view

ICC:

Intra-class correlation coefficient

LBP:

Low back pain

MRI:

Magnetic resonance imaging

NRS:

Numerical rating scale

ODI:

Oswestry Disability Index

PDQ:

Pain-Detect Questionnaire

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Acknowledgments

The authors thank the staff at the Department of Radiology, Bispebjerg and Frederiksberg Hospital for their support running the study. The authors thank radiologists Jacob Grindsted, MD, and Zoreh Rasti, MD, Department of Radiology, Frederiksberg Hospital, Denmark, for inspiration, evaluation of the MR images, and discussions. The authors would also like to thank Sabrina Mai Nielsen for statistical support and methodological feedback.

Funding

This study was supported by unrestricted grants from The Oak Foundation (grant number: OCAY-13-309), the Danish Rheumatism Association, and Frederiksberg and Bispebjerg Hospital.

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Corresponding author

Correspondence to Cecilie Lerche Nordberg.

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Guarantor

The scientific guarantor of this publication is Bjarke Brandt Hansen, MD, PhD.

Conflict of interest

Mikael Boesen has been an invited speaker regarding the use of G-scanner for imaging of the lumbar spine for ESAOTE, Genoa, Italy, the manufacturer of the G-scanner, at ESSR 2012, 2014 and 2017, Modena Meeting Nov. 2013, Imola Meeting June 2017, and ECR 2014 as well as the 1st, 2nd, and 3rd International Weight-bearing Meeting (2016, 2018, and 2019). Philip Hansen has received a travel grant from ESAOTE for the 1st International Weight-bearing Meeting 2016. The other authors have no conflict of interests to declare.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Local Ethics Committee approval: KF 01–045/03.

Methodology

• prospective

• cross-sectional study

• single-center study

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Nordberg, C.L., Boesen, M., Fournier, G.L. et al. Positional changes in lumbar disc herniation during standing or lumbar extension: a cross-sectional weight-bearing MRI study. Eur Radiol 31, 804–812 (2021). https://doi.org/10.1007/s00330-020-07132-w

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Keywords

  • Magnetic resonance imaging
  • Low back pain
  • Spine
  • Intervertebral disc displacement
  • Weight-bearing