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Influence of anatomical variations on lumbar foraminal stenosis pathogenesis

Merckaert, Sophie ; Pierzchala, Katarzyna ; Kulik, Gerit ; Schizas, Constantin

In: European Spine Journal, 2015, vol. 24, no. 2, p. 313-318

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    Titel
    • Influence of anatomical variations on lumbar foraminal stenosis pathogenesis
    Autor
    • Merckaert, Sophie. Orthopedic Department, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, 1011, Lausanne, Switzerland
    • Pierzchala, Katarzyna. Orthopedic Department, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, 1011, Lausanne, Switzerland
    • Kulik, Gerit. Orthopedic Department, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, 1011, Lausanne, Switzerland
    • Schizas, Constantin. Orthopedic Department, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, 1011, Lausanne, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • European Spine Journal, 2015, vol. 24, no. 2, p. 313-318. Springer Berlin Heidelberg
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:331583
    Summary
    Introduction: Symptomatic foraminal stenosis has been observed in patients with degenerative disc disease, scoliosis, asymmetrical disc degeneration and spondylolisthesis. Nevertheless not all patients with the above pathologies will develop symptomatic foraminal stenosis. We hypothesised that symptomatic patients have anatomical predisposition to foraminal stenosis, namely a larger pedicle height (PH) to vertebral body height (VH) ratio, leaving less room below the pedicle for the exiting nerve root compared to asymptomatic patients. Patient sample: 66 Patients were divided in two groups. The surgical group consisted of 37 patients (average age of 61years) who presented with severe radicular symptoms resisting to conservative measures and requiring decompression and transforaminal lumbar interbody fusion (TLIF). The control group consisted of 29 patients (average age of 51years) presenting with low back pain (LBP) but with no radicular symptoms and who were treated conservatively. Methods: We measured VH at the level of the posterior wall as well as PH on parasagittal images (CT or MRI) on all lumbar levels (L1 to L5). Statistical analysis was performed using Student's t test. Results: No difference in PH was found between the two groups for L1 to L4 levels. By contrast, there was a highly statistically significant difference in VH between the two groups from L1 to L4 level. In the surgical group, the VH was smaller (p<0.001). Conclusions: Symptomatic patients with foraminal stenosis have smaller VH leading to lesser space beneath the pedicle and putting the exiting nerve root at risk in cases of spondylolisthesis or disc degeneration.