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Lee, Lee, Oh, Lee, and Koo: Effect of Axial loading on Lumbar spine MRI -Comparative Study of Effect between a Patient Group with Claudication and a Patient Group without Claudication-
Original Research

J Korean Soc Spine Surg 2012;19(4):152-157.

Published online: 18 December 2012

DOI: https://doi.org/10.4184/JKSS.2021.19.4.152

Effect of Axial loading on Lumbar spine MRI -Comparative Study of Effect between a Patient Group with Claudication and a Patient Group without Claudication-

Jin-Young Lee, M.D., Jeong-Gil Lee, M.D., Bum-Suk Oh, M.D., Hyo-Beom Lee, M.D., Bon-Jae Koo, M.D.

Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea

Corresponding author: Jeong-Gil Lee, M.D. Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, Kil dong 445, Kang-dong Gu, Seoul, Korea TEL: 82-2-2224-2350, FAX: 82-2-489-4391 E-mail: finedr@hanmail.net

Received 2 January 20127 September 2012       Accepted 10 December 2012

© Copyright 2012 Korean Society of Spine Surgery

“This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.”

Abstract

Study Design

This study intended to find out differences of effects by axial loading in MRI examination in a patient group with neurologic claudication and a group without neurologic claudication

Objectives

It was intended to understand in which group the effects of axial loading can be expected when taking MRI on the lumbar spine.

Summary of Literature Review

The study of Willen and Danielson found spinal canal stenosis, which cannot be found by existing methods comparing an MRI taken in bended posture of lumbar without axial loading implementation by MRI taken with axial loading implementation. Hiwatashi et al. also reported that there was a change of treatment direction by laminectomy after axial loading in patients who were intended to take a conservational treatment before the axial loading.

Materials and Methods

A total of 39 patients and 54 intervertebral discs were compared. The distances from a sagittal plane before and after intervertebral discs were compared by measuring a sectional area of dura mater in a horizontal plane image and two groups were compared by existence of patients’ neurologic claudication.

Results

The AP diameter before and after a intervertebral discs increased into 41.98 mm from 41.1 mm on the average and the sectional area of dura mater showed 137.47mm2 before loading and 119.86mm2 after loading on the average. There was not a significant difference in the distances before and after axial loading implementation, but a significant difference was found in the sectional area of dura mater.

Conclusion

Axial loading would contribute to diagnose spinal disease, and especially, spinal canal stenosis in a patient group with claudication.

Keywords: Lumbar MRI, Axial loading MRI, Spinal stenosis, Claudication

REFERENCES

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Fig. 1.
Dynawell L-spine compression device.
jkss-19-152f1.tif
Fig. 2.
Preloading and postloading sagittal view of 51years old male patient, it shows increase of AP diameter after axial loading.
jkss-19-152f2.tif
Fig. 3.
Preloading and postloading axial view of 51 years old male patient, it shows sectional area of dura mater decrease after axial loading.
jkss-19-152f3.tif
Table 1.
Descriptions of patient
Group Age Gender Pre-diameter Post-diameter Pre-width Post-width Level
A 41 F 39.71 40.27 137.53 102.34 L4-5
41 M 40.15 42.99 153.14 148.93 L3-4
    43.41 44.07 161.21 155.11 L4-5
42 F 37.83 38.51 102.32 98.63 L4-5
46 F 36.7 37.24 102.42 92.16 L5-S1
47 M 41.14 41.87 128.42 116.18 L4-5
47 F 40.13 40.74 114.36 106.34 L4-5
    41.15 41.86 98.44 96.32 L5-S1
48 M 42.84 43.52 256.3 221.47 L4-5
50 F 38.72 39.12 102.34 98.27 L3-4
    39.32 40.12 106.27 101.8 L4-5
53 M 43.27 44.02 183.47 152.83 L4-5
53 F 37.42 37.93 136.41 124.2 L4-5
54 F 38.23 39.12 141.39 123.2 L4-5
54 F 41.45 41.92 164.41 163.28 L4-5
    40.21 41.04 132.12 117.94 L5-S1
56 F 42.73 42.98 143.21 131.01 L4-5
57 F 38.49 38.72 146.21 121.84 L4-5
58 F 39.27 40.74 157.43 129.83 L5-S1
59 F 36.94 38.67 174.31 167.72 L3-4
    36.21 36.91 178.35 169.92 L4-5
61 M 43.64 45.03 143.27 131.02 L4-5
62 M 45 45.7 216.05 208.26 L4-5
    43.95 44.3 271.29 251.44 L5-S1
64 F 37.37 37.62 178.35 166.12 L4-5
    37.97 38.32 117.79 116.92 L5-S1
B 40 F 41.23 41.93 106.78 82.61 L4-5
42 F 40.64 40.72 99.02 82.89 L5-S1
43 F 39.56 40.97 201.57 167.92 L4-5
44 M 43.6 43.84 100.98 87.63 L4-5
    44.3 44.86 75.02 56.61 L5-S1
44 F 39.73 40.21 143.34 122.71 L4-5
    43.36 44.91 128.22 106.48 L5-S1
46 M 42.27 42.74 117.39 97.29 L4-5
    42.62 43.12 98.21 74.37 L5-S1
48 M 42.47 43.16 131.44 117.65 L3-4
48 F 38.42 40.18 143.57 120.43 L4-5
51 M 41.79 42.85 82.29 54.38 L4-5
    43.83 46.74 79.6 48.52 L5-S1
52 F 41.13 42.58 82.25 72.42 L4-5
    39.38 39.43 64.52 61.43 L5-S1
53 M 43.65 44.08 243.61 204.24 L4-5
53 F 43.31 44.16 102.3 72.48 L3-4
    43.27 43.83 104.47 82.64 L4-5
54 M 43.51 44.21 102.31 83.72 L3-4
    43.23 43.81 103.21 84.3 L4-5
57 F 41.24 42.72 173.28 154.82 L4-5
58 F 38.61 39.41 163.21 141.78 L5-S1
58 M 41.37 43.62 237.09 210.86 L4-5
61 M 41.26 42.83 175.94 132.27 L4-5
62 M 44.5 46.52 102.59 82.62 L4-5
    43.55 44.75 87.49 61.06 L5-S1
64 F 42.19 42.24 105.68 85.78 L4-5
64 F 42.35 43.11 121.32 109.48 L4-5

A: Patients without claudication, B: Patients with claudication

Table 2.
Patients classified by age.
Age A   B
40 ~ 50 8   8
51 ~ 60 8   8
60 ~ 3   4
P-value   0.922  

A: Patients without claudication, B : Patients with claudication

Table 3.
Mean values between preloading vs postloading
  Diameter Width
Preloading 41.1 137.47
Postloading 41.98 119.86
P-value 0.06 0.05
Table 4.
Mean difference between patients with/without claudication
  Diameter Width
A 0.772 12.835
B 0.977 22.046
P-value 0.307 0.001

A : Patients without claudication, B : Patients with claudication

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