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The Response of the Nucleus Pulposus of the Lumbar Intervertebral Discs to Functionally Loaded Positions

Alexander, Lyndsay A., BSc*; Hancock, Elizabeth, MSc*; Agouris, Ioannis, PhD*; Smith, Francis W., MD; MacSween, Alasdair, PhD*

doi: 10.1097/BRS.0b013e318067dccb

Study Design. Asymptomatic volunteers underwent magnetic resonance imaging to investigate how different positions affect lumbar intervertebral discs.

Objective. To quantify sagittal migration of the lumbar nucleus pulposus in 6 functional positions.

Summary of Background Data. Previous studies of the intervertebral disc response in the sagittal plane were limited to imaging of recumbent positions. Developments of upright magnetic resonance imaging permit investigation of functional weight-bearing positions.

Methods. T2-weighted sagittal scans of the L1–L2 to L5–S1 discs were taken of 11 volunteers in standing, sitting (upright, flexed, and in extension), supine, and prone extension. Sagittal migration of the nucleus pulposus was measured (mm) as distance from anterior disc boundary to peak pixel intensity. Lumbar lordosis (Cobb angle) was measured in each position.

Results. Fifteen comparisons between positions showed significant positional effects (14 at L4–L5, L5–S1, the most mobile segments). Prone extension and supine lying induced significantly less posterior migration than sitting. Flexed and upright sitting, significantly more than standing at L4–L5, as did flexed sitting compared with extended.

Conclusion. These results support for the first time the validity of clinical assumptions about disc behavior in functional positions: sitting postures may increase risk of posterior derangement, and prone and supine may be therapeutic for symptoms caused by posterior disc displacement.

Functional positions showed significant effects on posterior migration at L4–L5 and L5–S1: prone and supine, lying less than sitting; sitting in extension, less than flexed. This supports assumptions that sitting may increase risk of posterior displacement, while prone and supine lying may be therapeutic where symptoms arise from posterior displacement.

From the *Robert Gordon University, Aberdeen, U.K.; and †Positional MRI Centre, Woodend Hospital, Aberdeen, U.K.

Acknowledgment date: June 29, 2006. First revision date: November 3, 2006. Acceptance date: December 8, 2006.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Lyndsay A. Alexander, BSc, School of Health Sciences, Faculty of Health and Social Care, Robert Gordon University, Garthdee Road, Aberdeen, AB10 7QG, U.K.; E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.