30% of Disc Herniations are Missed on Advanced Imaging

30% of Disc Herniations are Missed on MRI

It has been shown in prior studies that in patients with a suspected intervertebral disc herniation, on physical examination 30% are not confirmed by traditional MRI. Zou et al. (2008) studied lumbar disc herniation with functional loading or with weight bearing in flexion-extension views. This is important, as it puts “functional stress” on the spine, particularly in the position that produces symptoms. The results of the study showed that a significant increase in intervertebral disc herniation was diagnosed when additional flexion-extension views were added. Intradiscal pressure also changes with lumbar spine position. Flexion and extension MRI views provide added information when assessing patients for lumbar disc herniations, and may be especially useful in situations where symptomatic radiculopathy is present with unimpressive conventional MRI studies. In this study it was found that there was approximately a 14% increase of herniated discs compared to conventional MRI during extension views, rendering a more accurate diagnosis.

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Reference:

Zou, J., Yang, H., Miyazaki, M., Wei, F., Hong, S. W., Yoon, S. H.,...Wang, J. C. (2008). Missed lumbar disc herniations diagnosed with kinetic magnetic resonance imaging. Spine, 33(5), E140-E144.