Efficacy of computed tomography in prediction of operability of L5/S1 foraminal stenosis using region of interest

Abstract

Symptoms of intervertebral foraminal stenosis are caused by compression of nerve root exiting the intervertebral foramen. Many attempts to measure the size of the neuromuscular exit have been made; however, only a few studies to compare the area differences between foramens by computed tomography (CT) were done. In this retrospective comparative study, we used the region of interest (ROI) in CT to measure and compare the area of intervertebral foramen between the healthy control group and the patient group.Eighty-one patients who underwent CT of the lumbar spine between May 2014 and December 2017 were enrolled. Using the medical imaging program, the foraminal area between L5 and S1 vertebrae was measured on the sagittal, coronal, and axial planes using ROI. Four groups were established for comparison: those diagnosed with foraminal stenosis by a radiologist and those who were not, those diagnosed with foraminal stenosis by orthopedic surgeons and those who were not. These groups were further divided into subcategories depending on whether the area was operated on for foraminal stenosis. Interobserver and intraobserver agreements were assessed.The mean age of patients was 56.5 years (range 17–84). The foraminal area of the surgical group on sagittal plane was significantly narrower than the control group (P = .005). However, the difference between the 2 groups on axial and coronal planes was not statistically significant (P > .1). Foraminal area <80 mm2 on sagittal images was a statistically significant risk factor for clinical symptom (P = .028) and that <65 mm2 was a statistically significant risk factor in predicting operability (P = .01). Interobserver and intraobserver agreements were fair to good on axial and coronal planes (about 0.7), whereas the agreements were excellent on sagittal plane (>0.9).In this study, we proved that measuring the intervertebral foraminal area using the ROI in CT in the lumbar spine is useful for diagnosing L5-S1 foraminal stenosis, especially on sagittal plane. Furthermore, not only does it provide aid in diagnosis, but it also helps predicting the operability of foraminal stenosis.

Intervertebral Canals and Intracanal Ligaments as New Terms in Terminologia anatomica

“…Anatomical studies to supplement classical morphological teachings and improve treatment tactics for diseases of the cervical part of the vertebral column are still underway [19][20][21]. However, most authors who made lateral structures of the spine the subject of their scientific research either completely omitted intervertebral canals or their description did not include soft tissues and transverse processes of the vertebrae.…”

CT measures of osseous cervicothoracic intervertebral foramina are repeatable and associated with CT measures of adjacent articular processes in horses

“…Previous studies reported that caudal cervical AP (from C5 to T1) were more frequently enlarged 5,9,14 . In companion animals and humans, the assessment of IF narrowing relies mainly on cross‐sectional imaging (CT or MRI) and various measurements have been described to objectively assess the dimensions of the IF; this includes the height, width, cross‐sectional area (CSA), and volume of the IF 15–24 . In humans, APCSA measured using MRI was a good predictor of cervical IF stenosis which was easy to use and fast to measure 25 .…”

“…In humans, APCSA measured using MRI was a good predictor of cervical IF stenosis which was easy to use and fast to measure 25 . CT measurement of IFCSA in sagittal plane have been proven useful for diagnosing and to help predicting the operability of people with lumbosacral IF stenosis 17 . In previous CT studies in horses, IF dimensions were assessed by measuring IF height or length 5,26 and AP dimensions were assessed by measuring their CSA, 5,11 but published studies assessing the IFCSA and the association between measurements of the AP and the size of the IF are still lacking.…”

“…5,9,14 In companion animals and humans, the assessment of IF narrowing relies mainly on crosssectional imaging (CT or MRI) and various measurements have been described to objectively assess the dimensions of the IF; this includes the height, width, cross-sectional area (CSA), and volume of the IF. [15][16][17][18][19][20][21][22][23][24] In humans, APCSA measured using MRI was a good predictor of cervical IF stenosis which was easy to use and fast to measure. 25 CT measurement of IFCSA in sagittal plane have been proven useful for diagnosing and to help predicting the operability of people with lumbosacral IF stenosis.…”

“…25 CT measurement of IFCSA in sagittal plane have been proven useful for diagnosing and to help predicting the operability of people with lumbosacral IF stenosis. 17 In previous CT studies in horses, IF dimensions were assessed by measuring IF height or length 5,26 and AP dimensions were assessed by measuring their CSA, 5,11…”