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

Wednesday, July 20th, 2016
Female doctor looking at spinal MRIs

Welcome to part IV of the series we’ve been doing called, “Can Disc Herniations Actually Be Worse Than The MRI Shows?” My question, as stated in Parts I, II, and III 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 disagreements 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 IV with a paper called, “Axial loading during magnetic resonance imaging in patients with lumbar spinal canal stenosis: does it reproduce the positional change of the dural sac detected by upright myelography?” by Kanno et. al.

Why They Did It

The objective was to answer the same question. Does an axial loaded MRI change the anatomy of the vertebral segments including the neural structures?

How They Did It

  • 44 patients participated.
  • Imaging was done in the conventional manner and in the axial loaded manner.
  • The size of the dural sack (the sack around the spinal cord) was measured in each type of imaging.

What They Found

  • The size of the dural sack was significantly reduced in the axial loaded imaging.
  • “The axial loaded MRI detected severe constriction with a higher sensitivity (96.4%) and specificity (98.2%) than the conventional MRI.”

Wrap It Up

MRIs performed with axial loads showed significant changes in the size of the dural sack diameters. The axial loaded MRI is useful in representing positional changes similar to those experienced when upright and weight-bearing.

Kanno H, et al. “Axial loading during magnetic resonance imaging in patients with lumbar spinal canal stenosis: does it reproduce the positional change of the dural sac detected by upright myelography?” Spine (Phila Pa 1976). 2012 Jul 15;37(16):E985-92.
http://www.ncbi.nlm.nih.gov/m/pubmed/21258271/?i=6&from=axial%20loaded%20disc%20MRI

Next, we cover a paper called, “Axially loaded magnetic resonance image of the lumbar spine in asymptomatic individuals.” This paper was done by Danielson et. al. in 2001.

Why They Did It

“To evaluate the effect of axial loading on asymptomatic individuals, as compared with the effect on patients who have clinical signs of lumbar spinal canal stenosis, and to assess the effect that different magnitude and duration of the applied load have on the dural cross-sectional area.”

How They Did It

  • MRIs were performed lying down as well as upright on the participants.
  • The axial loading was performed lying down, face up with a “compression device” made for this study specifically.
  • Degenerative changes were noted in and around the spinal canal.
  • The diameter of the dural sack was measure in the lying down and in the upright position.

What They Found

The authors said, “A significant decrease in dural cross-sectional area from psoas-relaxed position to axial compression in extension was found in 24 individuals (56%), most frequently at L4-L5, and increasingly with age.”

Wrap It Up

Using axial loaded MRI imaging demonstrated a significant reduction in the size of the dural sack. Especially in the patients that were already suffering symptoms.

Danielson B, et al. “Axially loaded magnetic resonance image of the lumbar spine in asymptomatic individuals.” Spine (Phila Pa 1976). 2001.
http://www.ncbi.nlm.nih.gov/m/pubmed/11725242/?i=15&from=axial%20loaded%20disc%20MRI

Well, there you have it. Since beginning this series, we have covered 12 research papers dealing with this topic specifically and it is exceedingly clear that indeed, upright or axial loaded MRIs are significantly superior to MRIs performed in the lying down position in regards to diagnosing herniated disc severity.

If your MRI says 4 mm and was performed in the lying down position, then it is a researched reality that the actual size of the disc herniation will likely be variable and much more significant with weight bearing activities. These include bending to the side, bending forward, bending backward, and performing activities of daily living and work responsibilities.

Now, what can be done about these disc herniations? Does surgery HAVE to be explored? What about spinal injections or pain meds?

Not necessarily. In fact, in many (if not most) instances, a patient will benefit significantly or completely recover from a full regimen of Cold Laser-Enhanced Spinal Decompression. Here is a list of resources to learn more about what I’m suggesting.

http://www.amarillodecompression.com

https://youtu.be/QOC_usaEgFQ?list=PLjSzBSyj9Riva_RsgOcc5V2dMORriOA15

https://youtu.be/sRFv2BsfGYE?list=PLjSzBSyj9Riva_RsgOcc5V2dMORriOA15

https://youtu.be/a_kLyOAx5RE?list=PLjSzBSyj9Riva_RsgOcc5V2dMORriOA15

https://youtu.be/5H2dNIFixm4?list=PLjSzBSyj9Ris_kd6NXq85hx7ui1DJk64m

https://www.amarillochiropractor.com/everyone-know-disc-herniations-non-surgical-spinal-decompression/

/spinal-decompression-entry-point-into-the-system-for-herniated-disc/

/research-impressive-effectiveness-shown-in-spinal-decompression-medical-study/

/spinal-decompressions/

/research-restoration-of-disc-height-through-spinal-decompression/

/what-are-you-not-being-told-about-spinal-injections/

We hope you’ve enjoyed this series and found it interesting and educational. Please share this blog and help us get the word out about decompression and how it may help more and more avoid surgeries and potentially harmful injections.