European Journal of Radiology 81 (2012) e561–e564 Contents lists available at ScienceDirect European Journal of Radiology jo ur n al hom epage: www.elsevier.com/locate/ejrad Magnetic resonance imaging of the lumbar spine with axial loading: A review of 120 cases Andre Kinder a,b,1 , Fernando Palma Filho b,2 , Elisio Ribeiro b,3 , Romeu C. Domingues b,4 , Roberto C. Domingues b,4 , Edson Marchiori a,5 , Emerson Gasparetto a,b,* a Department of Radiology, Federal University of Rio de Janeiro School of Medicine, Rio de Janeiro, Brazil b Clinica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil a r t i c l e i n f o Article history: Received 14 March 2011 Accepted 7 June 2011 Keywords: Magnetic resonance imaging Lumbar spine Axial loading Spinal stenosis a b s t r a c t Purpose: To evaluate the imaging findings of patients with clinical symptoms of lower back pain who underwent magnetic resonance imaging (MRI) of the lumbar spine with axial loading. Materials and methods: We examined 120 patients by MRI, before and after axial loading, using a com- pression device that applied 50% of their body weight for a load time of 5 min. The dural sac cross area (DSCA) was examined by two experienced radiologists before and after axial load, and their findings were compared. Degenerative abnormalities within and adjacent to the spinal canal were also analyzed. Results: A reduction in DSCA greater than 15 mm 2 after axial load was defined as significant, and was found in 81 patients (67.5%) and 138 disc spaces (38.3%). Reduction was most frequent at L4-L5 (n = 55). For other disorders, a 9% increase in cases of bulging disc was seen during axial loading, and seven disc spaces showed protrusion/extrusion only after load. Facet joint synovial cysts, foraminal stenosis, and hypertrophy of the flavum ligaments showed almost no differences, pre- and post-load. Conclusion: For adequate evaluation of lumbar symptoms, examination should be performed with axial loading, especially in cases of suspected spinal stenosis. © 2011 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Lower back pain from degenerative changes in the lumbar spine commonly occurs in patients over 50 years. Bulging discs, hernias, facet joint synovial cysts, foraminal stenosis, spinal canal steno- sis, ligamentous hypertrophy, and other degenerative changes are common in this age group [1,2]. In the cases of spinal stenosis, * Corresponding author at: Hospital Universitário Clementino Fraga Filho/UFRJ, Rua Professor Rodolpho Paulo Rocco, no. 255, Departamento de Radiologia, Subsolo, CEP: 21941-617 Ilha do Fundão, Rio de Janeiro, RJ, Brazil. Tel.: +55 21 2562 2568; fax: +55 21 2562 2568. E-mail addresses: kinder.andre@gmail.com (A. Kinder), fernandopalma@globo.com (F.P. Filho), ejsalgado@globo.com.br (E. Ribeiro), romeu@cdpi.com.br (R.C. Domingues), robertodomingues@cdpi.com.br (R.C. Domingues), edmarchiori@gmail.com (E. Marchiori), egasparetto@gmail.com (E. Gasparetto). 1 Contact address: Rua Dr. Nelson de Sá Earp, 144, 401, Centro, Petrópolis, CEP: 25680-195, Brazil. 2 Contact address: Rua Saddock de Sá, 266, Ipanema, CEP: 22411-040 Rio de Janeiro, Brazil. 3 Contact address: Av. Rainha Elizabeth 371 ap 607, Copacabana, CEP: 22081-031 Rio de Janeiro, Brazil. 4 Contact address: Av. das Américas, 4666, grupos 302A, Barra da Tijuca, CEP: 22790-972 Rio de Janeiro, Brazil. 5 Contact address: Rua Thomaz Cameron, 438, Valparaiso, CEP: 25685-120 Petrópolis, Rio de Janeiro, Brazil. changes in posture and certain physical activities are known to have a dramatic effect on symptoms. Typically, standing, walking, and sometimes even sitting can increase the severity of symptoms by reducing the available space within the spinal canal [3], exacer- bating the degenerative changes. Previous studies have questioned the validity of diagnostic imaging, including tomography and mag- netic resonance imaging (MRI) performed in supine position, in evaluating patients with lower back pain [4–6]. MRI has replaced other diagnostic tools in examining patients with lower back pain because of its multiplanar capability, and the high contrast seen between different tissues. The disadvantage of MRI is that it is performed in a supine relaxed position. Previous studies indicated that during MRI of the lumbar spine for evaluation of back pain, the application of axial loading might improve diag- nostic accuracy [7,8]. Moreover, degenerative changes in patients with hernias, facet joint synovial cysts, foraminal stenosis, and lig- ament hypertrophy could be identified or further evaluated only after the application of axial load. The aim of this study was to assess changes in lumbar spine MRI, pre- and post-axial load, in 120 patients with lower back pain. 2. Materials and methods This study included 120 patients (60 men and 60 women), aged between 20 and 92, with no history of spinal surgery, who under- 0720-048X/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2011.06.027