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Shin D, Brandt Z, Oliinik M, Im D, Marciniak M, Vyhmeister E, Razzouk J, Kagabo W, Ramos O, Oyoyo U, Wycliffe N, Lipa SA, Bono CM, Cheng W, Danisa O. Anatomic Parameters for Diagnosing Congenital Lumbar Stenosis Based on Computed Tomography of 1,000 Patients. J Am Acad Orthop Surg 2024:00124635-990000000-01061. [PMID: 39121540 DOI: 10.5435/jaaos-d-24-00425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Quantitative parameters for diagnosis of congenital lumbar stenosis (CLS) have yet to be universally accepted. This study establishes parameters for CLS using CT, assessing the influences of patient sex, race, ethnicity, and anthropometric characteristics. METHODS Interpedicular distance (IPD), pedicle length, canal diameter, and canal area were measured using 1,000 patients between 18 and 35 years of age who were without spinal pathology. RESULTS Irrespective of disk level, threshold values for CLS were 16.1 mm for IPD, 3.9 mm for pedicle length, 11.5 mm for canal diameter, and 142.5 mm2 for canal area. Notable differences based on patient sex were observed, with men demonstrating larger CLS threshold values with respect to IPD and canal area across all vertebral levels from L1 to L5. Based on patient anthropometric factors, no strong or moderate associations were observed between any spinal measurement and patient height, weight, or body mass index across all levels from L1 to L5. However, notable differences were observed based on patient race and ethnicity from L1 to L5. Asian patients demonstrated the largest pedicle lengths, followed by White, Hispanic, and Black patients in descending order. White patients demonstrated the largest IPD, canal AP diameter, and canal area, followed by Asian, Hispanic, and Black patients in descending order. Black patients demonstrated the smallest values across all anatomic measurements relative to Asian, White, and Hispanic patients. CONCLUSION This study reports 25,000 measurements of lumbar central canal dimensions to establish quantitative thresholds for the diagnosis of CLS. Although not influenced by patient height, weight, or body mass index as one might intuit, canal dimensions were influenced by patient sex, race, and ethnicity. These findings may help explain differences in predisposition or prevalence of lumbar nerve root compression among patients of different races, which can be important when considering rates of surgery and access to care.
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Affiliation(s)
- David Shin
- From the Loma Linda University School of Medicine, Loma Linda, CA (Shin, Brandt, Oliinik, Im, Marciniak, Vyhmeister, Razzouk), Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD (Kagabo), Twin Cities Spine Center, Minneapolis, MN (Ramos), Department of Dental Education Services (Oyoyo), Department of Radiology (Wycliffe), Loma Linda University Medical Center, Loma Linda, CA, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Lipa), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Bono), Division of Orthopaedic Surgery, Jerry L. Pettis Memorial Veterans Hospital, Loma Linda, CA (Cheng), Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA (Danisa)
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Razzouk J, Case T, Vyhmeister E, Nguyen K, Carter D, Carter M, Sajdak G, Kricfalusi M, Taylor R, Bedward D, Shin D, Wycliffe N, Ramos O, Lipa SA, Bono CM, Cheng W, Danisa O. Morphometric analysis of cervical neuroforaminal dimensions from C2-T1 using computed tomography of 1,000 patients. Spine J 2024:S1529-9430(24)00219-5. [PMID: 38705281 DOI: 10.1016/j.spinee.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/22/2024] [Accepted: 05/01/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Race and sex differences are not consistently reported in the literature. Fundamentally, anatomical differences of cervical neuroforaminal dimensions (CNFD) amongst these groups would be important to know. PURPOSE To establish normative radiographic morphometric measurements of CNFD and uncover the influence of patient sex, race, and ethnicity while also considering anthropometric characteristics. STUDY DESIGN Retrospective radiographic morphometric study. PATIENT SAMPLE A total of 1,000 patients between 18 and 35 years of age who were free of spinal pathology. OUTCOME MEASURES Foraminal height, axial width, and area of cervical neural foramen. METHODS Cervical CTs were reviewed to measure CNFD, defined as follows: foraminal height, axial width, and area. Statistical analyses were performed to assess associations between CNFD, and patient height, weight, sex, race, and ethnicity. RESULTS CNFD measurements followed a bimodal distribution pattern moving caudally from C2-T1. Irrespective of disc level, cervical CNFD were as follows: left and right widths of 6.6±1.5 and 6.6±1.5 mm, heights of 9.4±2.4 and 9.4±3.2 mm, and areas of 60.0±19.5 and 60.6±20.7 mm2. Left and right foraminal width were highest at C2-C3 and lowest at C3-C4. Left and right foraminal height were highest at C7-T1 and C6-C7, respectively and lowest at C3-C4. Left and right foraminal areas were highest at C2-C3 and lowest at C3-C4. Significant differences were observed for all CNFD measurements across disc levels. CNFD did not vary based on laterality. Significant CNFD differences were observed with respect to patient sex, race, and ethnicity. Male height and area were larger compared to females. In contrast, female foraminal width was larger compared to males. The Asian cohort demonstrated the largest foraminal widths. White and Hispanic patients demonstrated the largest foraminal heights and areas. Black patients demonstrated the smallest foraminal widths, heights, and areas. Patient height and weight were only weakly correlated with CNFD measurements across all levels from C2-T1. CONCLUSIONS This study describes 36,000 normative measurements of 12,000 foramina from C2-T1. CNFD measurements vary based on disc level, but not laterality. Contrasting left- versus right-sided neuroforamina of the same level may aid in determining the presence of unilateral stenosis. Patient sex, race, and ethnicity are associated with CNFD, while patient anthropometric factors are weakly correlated with CNFD.
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Affiliation(s)
- Jacob Razzouk
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Trevor Case
- California University of Science and Medicine, 1501 Violet St, Colton, CA, 92324, USA
| | - Ethan Vyhmeister
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Kai Nguyen
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Davis Carter
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Mei Carter
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Grant Sajdak
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Mikayla Kricfalusi
- California University of Science and Medicine, 1501 Violet St, Colton, CA, 92324, USA
| | - Rachel Taylor
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Derran Bedward
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - David Shin
- Loma Linda University School of Medicine, 11175 Campus St, Loma Linda, CA, 92350, USA
| | - Nathaniel Wycliffe
- Department of Radiology, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Omar Ramos
- Twin Cities Spine Center, 913 E 26th St, Minneapolis, MN, 55404 USA
| | - Shaina A Lipa
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Christopher M Bono
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Wayne Cheng
- Division of Orthopaedic Surgery, Jerry L. Pettis Memorial Veterans Hospital, 11201 Benton St, Loma Linda, CA, 92357, USA
| | - Olumide Danisa
- Departments of Orthopaedic Surgery and Neurologic Surgery, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA, 92354, USA.
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Razzouk J, Case T, Brandt Z, Marciniak M, Sajdak G, Nguyen K, Small E, Petersen G, Kagabo W, Ramos O, Shaffrey CI, Cheng W, Danisa O. Normative Measurements of L1-S1 Segmental Angulation, Disk Space Height, and Neuroforaminal Dimensions Using Computed Tomography. Neurosurgery 2024; 94:813-827. [PMID: 38032205 DOI: 10.1227/neu.0000000000002761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To establish normative anatomic measurements of lumbar segmental angulation (SA) and disk space height (DSH) in relation to neuroforaminal dimensions (NFDs), and to uncover the influence of patient demographic and anthropometric characteristics on SA, DSH, and NFDs. METHODS NFDs, SA, and anterior, middle, and posterior DSH were measured using computed tomography of 969 patients. NFDs were defined as sagittal anterior-to-posterior width, foraminal height, and area. Statistical analyses were performed to assess associations among SA, DSH, NFDs, and patient height, weight, body mass index, sex, and ethnicity. RESULTS SA and DSH measurements increased moving caudally from L1 to S1. Foraminal width decreased moving caudally from L1 to S1. Foraminal height and area demonstrated unimodal distribution patterns with the largest values clustered at L2-L3 on the right side and L3-L4 on the left. Significant differences in SA, DSH, and NFD measurements were observed based on the disk level. Inconsistent, marginal NFD differences were observed based on laterality. Across all disk levels, only weak-to-moderate correlations were observed between SA and DSH in relation to NFDs. Patient height, weight, and body mass index were only weakly associated with SA, DSH, and NFDs. Based on patient sex, significant differences were observed for SA, DSH, and NFD measurements from L1 to S1, with males demonstrating consistently larger values compared with females. Based on patient race and ethnicity, significant differences in SA and NFD measurements were observed from L1 to S1. CONCLUSION This study describes 48 450 normative measurements of L1-S1 SA, DSH, and NFDs. These measurements serve as representative models of normal anatomic dimensions necessary for several applications including surgical planning and diagnosis of foraminal stenosis. Normative values of SA and DSH are not moderately or strongly associated with NFDs. SA, DSH, and NFDs are influenced by sex and ethnicity, but are not strongly or moderately influenced by patient anthropometric factors.
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Affiliation(s)
- Jacob Razzouk
- School of Medicine, Loma Linda University, Loma Linda , California , USA
| | - Trevor Case
- California University of Science and Medicine, Colton , California , USA
| | - Zachary Brandt
- School of Medicine, Loma Linda University, Loma Linda , California , USA
| | - Mary Marciniak
- School of Medicine, Loma Linda University, Loma Linda , California , USA
| | - Grant Sajdak
- School of Medicine, Loma Linda University, Loma Linda , California , USA
| | - Kai Nguyen
- School of Medicine, Loma Linda University, Loma Linda , California , USA
| | - Easton Small
- School of Medicine, Loma Linda University, Loma Linda , California , USA
| | - Garrett Petersen
- School of Medicine, Loma Linda University, Loma Linda , California , USA
| | - Whitney Kagabo
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore , Maryland , USA
| | - Omar Ramos
- Twin Cities Spine Center, Minneapolis , Minnesota , USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Duke University Medical Center, Durham , North Carolina , USA
| | - Wayne Cheng
- Division of Orthopaedic Surgery, Jerry L. Pettis VA Medical Center, Loma Linda , California , USA
| | - Olumide Danisa
- Department of Orthopaedic Surgery, Loma Linda University Health, Loma Linda , California , USA
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Razzouk J, Vyhmeister E, Carter D, Sajdak G, Nguyen K, Carter M, Kagabo W, Ramos O, Wycliffe N, Cheng W, Danisa O. Normative Measurements of L1 to S1 Neuroforaminal Dimensions Derived From Plain Film Radiography, Computed Tomography, and Magnetic Resonance Imaging. Spine (Phila Pa 1976) 2024; 49:432-442. [PMID: 37937514 DOI: 10.1097/brs.0000000000004857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/17/2024] [Indexed: 11/09/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To report normative measurements of L1 to S1 lumbar neuroforamina on plain film radiography (PFR), computed tomography (CT), and magnetic resonance imaging (MRI), accounting for patients' sex and ethnicity. BACKGROUND The quantitative criteria fothe diagnosis of neuroforaminal stenosis remains unknown. Acquiring a thorough understanding of normative foraminal dimensions is a key step in formulating objective parameters for neuroforaminal stenosis. PATIENTS AND METHODS We measured 988 images from 494 patients between 18 and 35 years old without spinal pathology who received PFR, CT, or MRI within 1 year of each other. Neuroforaminal measurements were defined as the height, area, and sagittal and axial widths. Statistical analyses were performed to assess relationships among PFR, CT, and MRI-derived neuroforaminal measurements, as well as the influence of patients' sex and ethnicity. RESULTS 330 PFR, 377 CT, and 281 MRI were measured. Of these, 213 PFR and CT, 117 PFR and MRI, and 164 MRI and CT intrapatient images were compared. Statistically significant differences were observed among PFR, CT, and MRI measurements across all levels L1 to S1. PFR measurements were larger compared with those derived from CT and MRI. Weak-to-moderate correlations were observed between PFR and CT, PFR and MRI, and CT and MRI, with the magnitude of correlation decreasing caudally from L1 to S1. Variations in neuroforaminal anatomy were observed based on sex and ethnicity. CONCLUSION This study reports 25,951 measurements of normal L1 to S1 neuroforaminal anatomy assessed by PFR, CT, and MRI. The values reported in this study may be used as normative reference measurements of the lumbar neuroforamina. PFR measurements of the neuroforamina are larger compared with those derived from CT and MRI across all levels from L1 to S1. There is a poor correlation between PFR, CT, and MRI when measuring the lumbar neuroforamina. Differences in neuroforaminal anatomy are evident based on patients' sex and ethnicity.
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Affiliation(s)
- Jacob Razzouk
- School of Medicine, Loma Linda University, Loma Linda, CA
| | | | - Davis Carter
- School of Medicine, Loma Linda University, Loma Linda, CA
| | - Grant Sajdak
- School of Medicine, Loma Linda University, Loma Linda, CA
| | - Kai Nguyen
- School of Medicine, Loma Linda University, Loma Linda, CA
| | - Mei Carter
- School of Medicine, Loma Linda University, Loma Linda, CA
| | - Whitney Kagabo
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Omar Ramos
- Department of Orthopaedic Surgery, Twin Cities Spine Center, Minneapolis, MN
| | | | - Wayne Cheng
- Division of Orthopaedic Surgery, Jerry L. Pettis VA Medical Center, Loma Linda, CA
| | - Olumide Danisa
- Department of Orthopaedic Surgery, Loma Linda University Health, Loma Linda, CA
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Nguyen K, Razzouk J, Brandt Z, Carlson P, Vyhmeister E, Bouterse A, Wycliffe N, Cheng W, Danisa O. Anatomic Assessment of L1-S1 Neuroforaminal Dimensions Using Computed Tomography in 1,000 Patients: A Follow-Up Study. Global Spine J 2023:21925682231220043. [PMID: 38061394 DOI: 10.1177/21925682231220043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVES While the radiographic criteria for diagnosing central lumbar stenosis are well described, criteria for diagnosing neuroforaminal stenosis (NFS) are unclear. Prior research has utilized magnetic resonance imaging (MRI) to characterize neuroforaminal dimensions (NFDs). However, this approach has inherent limitations that can adversely impact measurement accuracy. Existing literature on the use of computed tomography (CT) to investigate normal NFDs is limited. The purpose of the present study was to describe normal lumbar NFDs that would aid in the establishment of objective quantitative criteria for the diagnosis of NFS. METHODS This study evaluated CT imaging of 494 female and 506 male subjects between 18 and 35 years of age to determine normal NFDs, specifically the sagittal anteroposterior width, craniocaudal height, and area. Statistical analyses were performed to assess differences in NFDs according to variables including sex, height, weight, body mass index, and ethnicity. RESULTS Without differentiating between sides or disc levels, mean NFDs were 8.71 mm for sagittal anteroposterior width, 17.73 mm for craniocaudal height, and 133.26 mm2 for area (n = 10,000 measurements each). Male subjects had larger NFDs than females at multiple levels. Asian and Caucasian subjects had larger NFDs than Hispanic and African American subjects at multiple levels. There were no associations between NFDs and anthropometric factors. CONCLUSIONS The present study describes normal lumbar NFDs in young, healthy patients. NFDs were influenced by sex and ethnicity but not by anthropometric factors.
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Affiliation(s)
- Kai Nguyen
- School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Jacob Razzouk
- School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Zachary Brandt
- School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Patricia Carlson
- School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Ethan Vyhmeister
- School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Alex Bouterse
- School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Nathaniel Wycliffe
- Department of Radiology, Loma Linda University, Loma Linda, CA, United States
| | - Wayne Cheng
- Jerry L Pettis Memorial Veterans Hospital, Loma Linda, CA, United States
| | - Olumide Danisa
- Department of Orthopedics, Loma Linda University, Loma Linda, CA, United States
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