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Chiropractic Research Review

Axial Loading Increases Diagnostic Specificity

In 84 patients with sciatica or neurogenic claudication, the structures in and adjacent to the lumbar spinal canal were observed by computed tomographic myelography (50 patients) or magnetic resonance imaging (34 patients) in a psoas-relaxed position and during axial compression in slight extension of the lumbar spine.

The dural sac cross-sectional area at L2 to S1, the deformation of the dural sac and the nerve roots, and the changes in the tissues surrounding the canal were observed so as to determine the mechanical effects on the lumbar spinal canal in a simulated upright position.

Results: Axial loading of the lumbar spine in computed tomographic scanning and magnetic resonance imaging is recommended in patients with sciatica or neurogenic claudication, when the dural sac cross-sectional area at any disc location is below 130 mm2 in conventional psoas-relaxed position, and when there is a suspected narrowing of the dural sac or the nerve roots (especially in the ventrolateral part of the spinal canal in a psoas-relaxed position). The diagnostic specificity of the spinal stenosis increases considerably when the patient is subjected to an axial load.

Willen J, Danielson B, Gaulitz A, et al. Dynamic effects on the lumbar spinal canal. Axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication. Spine, Dec. 1997;22(24), pp2968-76.

Chiropractic Research Review

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