Changes in the lumbar intervertebral foramen between supine and standing posture in patients with adult spinal deformity: a study with upright computed tomography

Naruhito Fujita, Mitsuru Yagi, Yoshitake Yamada, Yoichi Yokoyama, Minoru Yamada, Kota Watanabe, Masaya Nakamura, Takeo Nagura, Masahiro Jinzaki

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To quantitatively assess the impact of supine and standing positions on the morphological changes in the lumbar intervertebral foramen (LIF) in patients with adult spinal deformity (ASD) using upright CT and conventional supine CT. Materials and methods: Thirty patients with ASD were prospectively enrolled in this study. All subjects underwent standing whole spine posterior/anterior radiographs, lateral radiographs, and whole spine CT, both in the supine and upright standing positions. Two orthopedic surgeons independently measured nine radiographic parameters in the radiograph and the lumbar foraminal area (FA) and height (FH) in supine and upright CT. Statistical analyses were performed to evaluate the risk of LIF decrease when standing upright compared to the supine position. The chi-squared, t test, Pearson’s coefficients, intra- and inter-rater reliabilities, and ROC curves were calculated. The level of significance was set at p < 0.05. Results: Among the 300 LIFs, both the lumbar FA and FH were either increased or decreased by > 5% in approximately 30% of LIFs each. The FA decreased in the lower lumbar spine. The concave side had a significantly higher rate of decreased FA and FH than the convex side (p < 0.05 and < 0.05, respectively). ROC analysis showed that narrowing of the intervertebral disc (cutoff > 0.05°) is a risk factor for decreased FA and FH. Conclusions: This study describes the details of the changes in the neuroforamen using a novel upright CT. In patients with ASD, approximately 30% of LIFs either increased or decreased in size by > 5% when standing. The risk factors for LIF decrease are the lower lumbar spine, concave side, and narrow side of the disc wedge.

Original languageEnglish
Pages (from-to)215-224
Number of pages10
JournalSkeletal Radiology
Volume52
Issue number2
DOIs
Publication statusPublished - 2023 Feb

Keywords

  • Adult spinal deformity
  • Lumbar foraminal stenosis
  • Lumbar intervertebral foramen
  • Upright computed tomography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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