A nerve root decompression position identified by 3D CT scan: the modified reversed contralateral axial rotation position for patients with lumbar disc prolapse

Ahmed Raffet; Mark Laslett; Raymond Lee; Noha Khaled; Ghada Abdel Moneim Mohamed; Hossam Y Sayed; Ahmed H Omar; Maged M Hawana; Mahmoud M Ali; Salam M Elhafez; Mohamed M ElMeligie; Hossam Eddein Fawaz

doi:10.1186/s13018-025-05762-8

A nerve root decompression position identified by 3D CT scan: the modified reversed contralateral axial rotation position for patients with lumbar disc prolapse

J Orthop Surg Res. 2025 Apr 17;20(1):386. doi: 10.1186/s13018-025-05762-8.

Authors

Affiliations

¹ Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
² The Sports Clinic, 156 Bealey Avenue, Christchurch, 8014, New Zealand.
³ Department of Biomechanics, Faculty of Technology, Portsmouth University, Portsmouth, UK.
⁴ Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁵ Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁶ Department of Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁷ Department of Physical Therapy for Neurology and its Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
⁸ Department of Basic Sciences for Physical Therapy, Faculty of Physical Therapy, Ahram Canadian University, Giza, Egypt. mohamed.elmeligie@acu.edu.eg.
⁹ Department of Basic Sciences for Physical Therapy, Faculty of Physical Therapy, Al Hayah University, Cairo, Egypt. mohamed.elmeligie@acu.edu.eg.

Abstract

Background: Nerve root compression in the lumbar intervertebral foramen (LIVF) is a consistent feature of radicular syndrome. There is debate about movements and positions that may reduce compression for possible use in conservative treatment.

Purpose: To investigate real-time effects of specific 3 dimensional positioning of the trunk on the cross sectional area (CSA) of the LIVF in patients with lumbar disc prolapse and radiculopathy using 3D-CT scan imaging.

Methods: Ninety males aged between 20 and 40 years with unilateral lumbar disc prolapse and radiculopathy were separated into three equal groups based on the level of disc prolapse. Group (A): L3/L4, group (B): L4/L5, and group (C): L5/S1. All underwent three separate imaging sessions; first in the supine position to establish baseline data (Baseline-Image 1), followed by a modified reversed contralateral axial rotation position (Image 2), and finally the same position as Image 2 but after 48 h of using the position as a therapeutic intervention (Image 3). The CSA of LIVF at L3/L4, L4/L5, and L5/S1 levels and the angles of straight leg raising (SLR) test were measured following each imaging session.

Results: Two-way mixed MANOVA analysis revealed that the mean values of the CSA of LIVF and the angle of SLR test were significantly increased in Image 2 compared with Baseline-Image 1 across all tested groups (P = 0.001). Moreover, the measured outcome variables were significantly increased in Image 3 compared with Image 2 and Baseline-Image 1 across all tested groups (P = 0.001).

Conclusion: The modified reversed contralateral axial rotation position of the trunk had a real-time decompression effect on the impinged nerve roots in patients with unilateral lumbar disc prolapse and radiculopathy.

Keywords: Lumbar disc prolapse; Lumbar intervertebral foramen; Modified reversed contralateral axial rotation position; Nerve root decompression position; Radiculopathy.

MeSH terms

Adult
Decompression, Surgical* / methods
Humans
Imaging, Three-Dimensional* / methods
Intervertebral Disc Displacement* / complications
Intervertebral Disc Displacement* / diagnostic imaging
Intervertebral Disc Displacement* / surgery
Lumbar Vertebrae* / diagnostic imaging
Lumbar Vertebrae* / surgery
Male
Patient Positioning* / methods
Radiculopathy* / diagnostic imaging
Radiculopathy* / surgery
Rotation
Spinal Nerve Roots* / diagnostic imaging
Spinal Nerve Roots* / surgery
Tomography, X-Ray Computed* / methods
Young Adult