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

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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.

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Funding

This study was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI (grant number 20K08056).

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan

    Naruhito Fujita, Mitsuru Yagi, Kota Watanabe, Masaya Nakamura & Takeo Nagura

  2. Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan

    Yoshitake Yamada, Yoichi Yokoyama, Minoru Yamada & Masahiro Jinzaki

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  1. Naruhito Fujita
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  2. Mitsuru Yagi
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Correspondence to Mitsuru Yagi or Takeo Nagura.

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Ethics approval and consent to participate

The present study was approved by the Japanese Ministry of Health, Labor, and Welfare, Japan Registry of Clinical Trails (jRCTs032180266). All methods were performed in accordance with the Declaration of Helsinki and the ethical standards of the institutional research committee. Signed informed consent was obtained from all individual participants included in the study.

Conflict of interest

One of the authors received a grant from Canon Medical Systems, which loaned the upright CT device to his institution. The funder was not involved in the design of the study; the collection, analysis, or interpretation of the data; or the writing of the manuscript. The other authors declare no competing interests.

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Supplementary file1 Intra- and inter-rater reliability ICC values (DOCX 76 KB)

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Fujita, N., Yagi, M., Yamada, Y. et al. Changes in the lumbar intervertebral foramen between supine and standing posture in patients with adult spinal deformity: a study with upright computed tomography. Skeletal Radiol 52, 215–224 (2023). https://doi.org/10.1007/s00256-022-04185-4

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