• Yung-Cheng Wang, Chin-Ming Jeng, Chau-Ying Wu, Hsio-Yun Chang, Yong-Chien Huang, Yu-Jen Wang, and Pa-Chun Wang.
• Department of Radiology, Cathay General Hospital, and School of Medicine, Fu Jen Catholic University, Taipei, Taiwan. edwardwg@seed.net.tw
• J Formos Med Assoc. 2008 Apr 1; 107 (4): 334-9.

BackgroundPrevious studies have shown that axial compression in extension (ACE) of the spine during magnetic resonance imaging (MRI) has revealed unexpected pathological features compared with the conventional psoas-relaxed position (PRP) used in imaging. The purpose of this study was to evaluate the dynamic effect of axial loading on lumbar spinal stenosis using MRI in patients with spinal stenosis.MethodsA total of 14 women and 11 men with lumbar spinal stenosis were examined in both PRP and ACE positions. We calculated the dural-sac cross-sectional area (DCSA) to evaluate severity of spinal canal stenosis. DCSA, as well as the dural-sac anteroposterior diameter (DAPD) and dural-sac transverse diameter (DTD) in both positions were measured using a digital image view station. A paired t test determined the differences in DCSA, DAPD and DTD between the two positions at each intervertebral disc level.ResultsAxial loading increased severity of lumbar spinal stenosis during MRI, as demonstrated by a decrease in DCSA from 20.5% to 6.3% (mean, 11.40 +/- 3.66%) between the PRP and ACE positions (p less than 0.01). Significant differences were also noted in DAPD and DTD between the PRP and ACE positions (p less than 0.01). A significant correlation was found between the decrease in mean DCSA and that in DAPD and DTD. The decrease in mean DCSA, DAPD and DTD following axial compression was greatest at the L4/5 and L5/S1 levels.ConclusionAxial loading increases severity of lumbar canal stenosis and the effect of axial loading on MRI examination is greatest at the L4/5 and L5/S1 levels.

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