Can Disc Herniations Actually Be Worse Than The MRI Shows? Part III

Friday, July 15th, 2016
Male doctor and female patient look at MRI

Welcome to part III of the series we’ve been doing called, “Can Disc Herniations Actually Be Worse Than The MRI Shows?” My question, as stated in Part I and Part II of this series, is, “If a low back (or lumbar) disc is 4 mm herniated while laying down in an MRI tube, what happens when the patient then sits up and becomes weight-bearing? Will the herniation increase or be affected at all?”

After some contradiction in discussions with radiologists, I decided to try to dive into the research at PubMed and answer the question for myself. I’m hoping you’ve found this interesting and it can help you decipher the information on your MRIs better going forward.

Let’s start Part III with a paper called, “Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines.” by Ferreiro Perez, et al.

Why They Did It

The authors had the same question in mind when they went about this study. They wanted to simply figure out the difference between MRIs done lying down and those done when in the seated position.

How They Did It

  • 89 Patients studied
  • 45 of them had their low back imaged
  • 44 patients had their necks imaged
  • The images were done in both the lying down position as well as the sitting.

What They Found

  • The overall combined recumbent (lying down) miss rate in cases of pathology was 15%
  • Overall combined recumbent underestimation rate in cases of pathology was 62%
  • Overall combined upright-seated underestimation in cases of pathology was 16%.

Wrap It Up

Upright-seated MRIs were seen to be superior to recumbent MRIs in 52 of the patients studied for conditions of posterior disc herniation and spondylolisthesis. Recumbent MRIs were only superior in 12% of the patients.

Ferreiro Perez A, et al.”Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines.” Eur J Radiol. 2007 Jun;62(3):444-8.
http://www.ncbi.nlm.nih.gov/m/pubmed/17412542/?i=12&from=sitting%20disc%20herniation%20mri

The second paper we’ll cover is called “Effect of intervertebral disk degeneration on spinal stenosis during magnetic resonance imaging with axial loading” by Ahn et al.

Why They Did It

They wanted to determine if disc degeneration will increase the severity of spinal stenosis when the spine is loaded with axial pressure.

How They Did It

  • 51 patients having symptoms of neurogenic intermittent claudication and/or sciatica had MRI imaging loaded as well as non-loaded.
  • All foramen and the spinal canal that neurologic structures run through were measured for changes in size.

What They Found

“More accurate diagnosis of stenosis can be achieved using MR imaging with axial loading, especially if grade 2 to 4 disk degeneration is present.”

Wrap It Up

Seated or loaded MRIs are superior for diagnostic purposes.

Ahn TJ, et al. “Effect of intervertebral disk degeneration on spinal stenosis during magnetic resonance imaging with axial loading.” Neurol Med Chir (Tokyo). 2009 Jun;49(6):242-7; discussion 247.
http://www.ncbi.nlm.nih.gov/m/pubmed/19556732/?i=31&from=/9612180/related

The last study we’ll look at this week is called “Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication” by Willen et al.

Why They Did It

The authors did this one for the same reason as the others; to find out if seated MRIs can give us more accurate diagnostic information in regards to those suffering neurologic symptoms resulting from disc herniations.

How They Did It

  • 50 subjects imaged with CT
  • 34 were imaged through MRI
  • The imaging was performed laying down as well as with an axial load applied.
  • Measurements of the anatomy were made to be able to distinguish any differences the loading may bring about.

What They Found

“Axial loading of the lumbar spine in computed tomographic scanning and magnetic resonance imaging is recommended in patients with sciatica or neurogenic claudication when the dural sac cross-sectional area at any disc location is below 130 mm2 in conventional psoas-relaxed position and when there is a suspected narrowing of the dural sac or the nerve roots, especially in the ventrolateral part of the spinal canal in psoas-relaxed position”

Wrap It Up

The value of the diagnostic information is significantly greater when the subject has an axial load applied during the imaging process.

Willén J, et al.”Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication.” Spine (Phila Pa 1976). 1997 Dec 15;22(24):2968-76.
http://www.ncbi.nlm.nih.gov/m/pubmed/9431634/?i=19&from=axial%20loaded%20disc%20MRI

By now it’s very clear that the seated MRI is more valuable in regards to the information you can get. One more part to go.

Don’t miss Part IV next week when we conclude this series.