A 68 year old female who had occult instability at a symptomatic osteoporotic L1 burst fracture was diagnosed
by manual axially loaded magnetic resonance imaging. Traction resulted in the reduction of the fracture and
decompression of the conus. Based on these findings, the patient underwent L1-L2 fusion with complete resolution of her
back and leg pain. Our objective is to describe the utility of such imaging in detecting an occult lumbar instability. This
study suggests that a manual axially loaded compression-traction magnetic resonance image may be an efficacious
diagnosis option in patients with persistent symptoms treated non-operatively.