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In Vivo 3-Dimensional Morphometric Analysis of the Lumbar Foramen in Healthy Subjects

Senoo, Issei MD*; Espinoza Orías, Alejandro A. PhD*; An, Howard S. MD*; Andersson, Gunnar B. J. MD, PhD*; Park, Daniel K. MD*,†; Triano, John J. DC, PhD; Inoue, Nozomu MD, PhD*

doi: 10.1097/BRS.0000000000000399
Anatomy

Study Design. In vivo 3-dimensional (3D) morphometric analysis of the lumbar foramen by using 3D computed tomographic models in normal subjects.

Objective. To describe foraminal geometry in an asymptomatic cohort measured in 3D.

Summary of Background Data. Appropriate assessment of the complex 3D lumbar foraminal geometry is key to correct radiculopathy diagnosis and treatment planning. To the best of our knowledge, there is no other study that quantifies the normal lumbar foramen 3D geometry considering sex, age groups, and spinal levels in vivo.

Methods. Subject-based 3D computed tomographic lumbar models were created in 59 asymptomatic volunteers and foraminal height and width were measured on the basis of the model by custom software. The foraminal height and width were compared by sex, age, and lumbar level.

Results. Overall, the foraminal height decreased with age. However, although the foraminal height in males decreased with age at all spinal levels, the foraminal heights in females did not. The foraminal height was significantly larger in the upper lumbar levels in both sexes. The foraminal width in males was significantly smaller than in females for all age groups. The foraminal width in both sexes also decreased similarly with age. The foraminal widths at the lower lumbar levels were significantly smaller than those at the upper levels. Age-related foraminal width decreases were seen in all lumbar levels as well.

Conclusion. This study described foraminal geometry in vivo in an asymptomatic cohort measured in 3D. Age-related foraminal height decrease was noticeable in males and in the lower lumbar levels. Age-related foraminal width decrease was shown in both sexes and in all lumbar levels. Such information can be used as baseline data for diagnosis of foraminal stenosis and treatment modality planning.

Level of Evidence: N/A

Lumbar foraminal geometry was measured 3-dimensionally by using computed tomographic models in vivo in an asymptomatic cohort. Age-related foraminal height decrease was noticeable in males and in the lower lumbar levels. Age-related foraminal width decrease was shown in both sexes and in all lumbar levels.

*Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL

Department of Orthopedic Surgery, William Beaumont School of Medicine, Oakland University, Rochester, MI; and

Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.

Address correspondence and reprint requests to Nozomu Inoue, MD, PhD, Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St, Ste 201 Orthopedic Building, Chicago, IL 60612; E-mail: Nozomu_Inoue@rush.edu

Acknowledgment date: October 31, 2013. Revision date: March 10, 2014. Acceptance date: April 15, 2014.

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

NIH grant funds were received in support of this work: NIAMS 5P01 AR48152-10 and NCCAM R01 AT006692-01A1.

Relevant financial activities outside the submitted work: board membership, consultancy, employment, expert testimony, grants, royalties, stocks.

© 2014 by Lippincott Williams & Wilkins