Evaluation of foraminal cross-sectional area in lumbar spondylolisthesis using kinematic MRI
- 50 Downloads
To evaluate the kinematic change of cross-sectional area of lumbar intervertebral foramen in degenerative lumbar spondylolisthesis patients using multi-positional MRI.
Multi-positional MRI was performed on 31 patients diagnosed with single or multilevel degenerative lumbar spondylolisthesis and 31 control patients without degenerative lumbar spondylolisthesis. Foraminal area (FA) was measured at the lumbar spondylolisthesis level in degenerative lumbar spondylolisthesis group and at L3-4, L4-5, and L5-S1 level in the control group. FA was measured bilaterally in neutral, flexion, and extension positions. The difference in FA between the groups was analyzed using Mann–Whitney U test, and the difference between positions within groups was analyzed using Wilcoxon signed-rank test.
Degenerative lumbar spondylolisthesis group showed significantly smaller FA on both sides and on average in all three positions compared to the control group (p < 0.05 all). From neutral to flexion position, the change in FA was significantly smaller in the degenerative lumbar spondylolisthesis group than in the control group on both sides and on average (p < 0.005 all). In degenerative lumbar spondylolisthesis group, the FA showed no significant change from neutral to flexion, but showed significant change from neutral to extension (p < 0.005 all).
FA in the degenerative lumbar spondylolisthesis group was smaller than in the control group. There was no difference in FA in degenerative lumbar spondylolisthesis group from neutral to flexion, only from neutral to extension. Patients with degenerative lumbar spondylolisthesis have a higher chance of developing foraminal stenosis.
KeywordsDegenerative spondylolisthesis Lumbar spondylolisthesis Foramina area Foraminal stenosis Degenerative lumbar Multi-positional MRI
The study was supported by departmental funds. Authors would like to thank AiM Radiology Medical Group, especially to Aziza Qadir MD for the help in overseeing the upload of multi-positional MRI images into the database.
Disclosures outside of submitted work: ZB—Xenco Medical (consultancy), AO Spine (consultancy); JCW—Royalties—Biomet, Seaspine, Amedica, DePuy Synthes; Investments/Options—Fziomed, Promethean, Paradigm Spine, Benvenue, Nexgen, Vertiflex, Electrocore, Surgitech, Expanding Orthopedics, Osprey, Bone Biologics, Pearldiver; Board of Directors—North American Spine Society (non-financial, reimbursement for travel for board meetings, courses etc.), North American Spine Foundation (non-financial), AO Foundation (financial, $20,000 honorariums for board positions, plus travel for board meetings), Cervical Spine Research Society (non-financial, reimbursement for travel for board meetings); Editorial Boards—Spine, JAAOS, The Spine Journal, Clinical Spine Surgery, Global Spine Journal; Fellowship Funding (paid to institution): AO Foundation. Yusuf A. Khan, Sameer U. Khan—family relationships (a family member owner of kMRI imaging center).
Compliance with ethical standards
Conflict of interest
No conflict of interest for the current study.
- 1.Jacobsen S, Sonne-Holm S, Rovsing H, Monrad H, Gebuhr P (2007) Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine (Phila Pa 1976) 32(1):120–125. https://doi.org/10.1097/01.brs.0000250979.12398.96 CrossRefGoogle Scholar
- 6.Wildermuth S, Zanetti M, Duewell S, Schmid MR, Romanowski B, Benini A, Boni T, Hodler J (1998) Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography. Radiology 207(2):391–398. https://doi.org/10.1148/radiology.207.2.9577486 CrossRefGoogle Scholar
- 7.Schmid MR, Stucki G, Duewell S, Wildermuth S, Romanowski B, Hodler J (1999) Changes in cross-sectional measurements of the spinal canal and intervertebral foramina as a function of body position: in vivo studies on an open-configuration MR system. AJR Am J Roentgenol 172(4):1095–1102. https://doi.org/10.2214/ajr.172.4.10587155 CrossRefGoogle Scholar
- 9.Havey RM, Goodsitt J, Khayatzadeh S, Muriuki M, Potluri T, Voronov LI, Lomasney LM, Patwardhan AG (2015) Three-dimensional computed tomography-based specimen-specific kinematic model for ex vivo assessment of lumbar neuroforaminal space. Spine (Phila Pa 1976) 40(14):E814–E822. https://doi.org/10.1097/brs.0000000000000959 CrossRefGoogle Scholar
- 12.Meyerding HW (1956) Spondylolisthesis; surgical fusion of lumbosacral portion of spinal column and interarticular facets; use of autogenous bone grafts for relief of disabling backache. J Int Coll Surg 26(5 Part 1):566–591Google Scholar
- 18.Hu SS, Tribus CB, Diab M, Ghanayem AJ (2008) Spondylolisthesis and spondylolysis. J Bone Jt Surg Am 90(3):656–671Google Scholar