Study Design: A pilot study of lumbar disc herniation patients examined with magnetic resonance imaging in
both psoas-relaxed position and axial compression in extension of the lumbar spine is described. Objective: To discuss the
clinical value of axially loaded magnetic resonance imaging in patients with lumbar disc herniation and to evaluate the
effect on the dural cross-sectional area. Summary of Background Data: Magnetic resonance imaging tests are performed
in a supine relaxed position. It is well documented that a narrowing of the spinal canal is provoked by axial loading,
especially when it is combined with spinal extension. Physiological or pathological changes due to loading effects might
thus remain undetected by conventional imaging tests. This unloading effect could lead surgeons to a diagnosis that does
not take into account these dynamic aspects. The present pilot study seeks to evaluate the effect of axial loading
compression on the dural cross-sectional area in patients with lumbar disc herniation. The purpose of this study is to help
surgeons in making treatment decisions or surgery indications. Methods: 15 patients underwent magnetic resonance
imaging examinations in both psoas-relaxed position and axial compression in extension using a compression device
(DynaWell®). An axial load corresponding to 50% of the body weight was applied. Changes in the dural cross-sectional
area were registered. Results: A significant decrease in dural cross-sectional area was found in only 2 patients (13.3%). In
13 patients, no significant changes in dural cross-sectional area were found. Concerning the overall results, no significant
differences were observed between both MRI. Conclusions: Using magnetic resonance imaging, no statistical significant
decrease in dural cross-sectional area after axial loading was found. These findings do not support the recommendation of
magnetic resonance imaging with axial compression in patients with sciatica secondary to lumbar disc herniation.
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