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. 2022 Apr 11;11(8):2122.
doi: 10.3390/jcm11082122.

Axial Loading during MRI Induces Lumbar Foraminal Area Changes and Has the Potential to Improve Diagnostics of Nerve Root Compromise

Hanna Hebelka  1   2 , Niklas Rydberg  1   2 , John Hutchins  1   3 , Kerstin Lagerstrand  1   4 , Helena Brisby  1   3
Affiliations

Axial Loading during MRI Induces Lumbar Foraminal Area Changes and Has the Potential to Improve Diagnostics of Nerve Root Compromise

Hanna Hebelka et al. J Clin Med. .

Abstract

Lumbar foraminal stenosis is a common cause of lumbar radiculopathy and conventionally assessed with magnetic resonance imaging (MRI) in supine-positioned patients. An MRI acquired during spine loading may unmask pathology not otherwise revealed in a relaxed position. Therefore, we investigated how spine loading during MRI affects lumbar foramina. In 89 low-back pain patients' lumbar, MRIs were performed in a relaxed supine position and during axial loading using a Dynawell® compression device. The smallest area of all intervertebral foramina at levels L3/L4-L5/S1 (534 foramina) was determined using a freehand polygonal tool in parasagittal T2-weighted sequences. The grading system described by Lee et al. was also used to qualitatively assess foraminal stenosis. Overall, a mean reduction of 2.2% (mean -0.89 cm2 and -0.87 cm2, respectively) was observed (p = 0.002), however for individual foramina large variations, with up to about 50% increase or decrease, were seen. Stratified for lumbar level, an area reduction was found for L3/L4 and L4/L5 foramina (mean change -0.03 cm2; p = 0.036; and -0.03 cm2; p = 0.004, respectively) but not for L5/S1. When comparing the measured area changes to qualitative foraminal grading, 22% of the foramina with a measured area decrease were evaluated with a higher grading. Thus, detailed information on foraminal appearance and nerve root affection can be obtained using this method.

Keywords: axial loading during MRI; diagnostics; lumbar foraminal area; lumbar foraminal stenosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A patient positioned in the Dynawell® compression device just about to undergo magnetic resonance imaging (MRI) examination.
Figure 2
Figure 2
MRI of a right L4–5 foramina without loading of the spine (a) and MRI of the same foramina acquired with axial loading (b). The measurement area is marked in both images and a reduction in the area was measured. The fat surrounding the nerve root is visually reduced in the MRI with loading.
Figure 3
Figure 3
MRI of a left L4–L5 foramina acquired without loading of the spine (a) and with loading (b). A change in the foraminal shape and increase in disc bulging can be observed; the nerve root is surrounded by fat in both MR images.
See this image and copyright information in PMC

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