Skip to main content
SpringerLink
Log in

Specific foraminal changes originate from degenerative spondylolisthesis on computed tomographic images

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Operative treatment for degenerative spondylolisthesis (DS) is accompanied by the high incidence of nerve injury. Foraminal structures, especially the hypertrophied facet joints, have significant impacts on the adjacent nerve. This study aims to identify the specific foraminal changes relating to DS and nerve injury.

Methods

The CT images of 70 patients with DS and 50 patients without lumbar disease were collected. The length and height of the foraminal structure were measured horizontally and vertically on sagittally reconstructed images. Horizontal stenosis, meaning to pending compression to nerve root after complete reduction, was evaluated on the image located to the middle of the foramen. Chi-square test or T-test were carried out using SPSS 26.0.

Results

The hyperplasia of the superior articular process (SAP) and articular capsule (Ac) incidence rates in DS group was significantly more common than that of the control group (9.2 vs 0.0%, 42.9 vs 2.0%). The height and width of the SAP and Ac in vertical and horizontal directions were significantly greater than those in the control group (4.95 mm vs − 0.47 mm, P < 0.0001; 3.28 vs 0.02 mm, P < 0.0001; 5.27 vs3.44 mm, P < 0.0001; 2.60 vs 0.37 mm, P < 0.0001). In the DS group, hyperplasia of the SAP and Ac accounted for 9 and 43% respectively, 85 and 45% of which were accompanied by horizontal stenosis of the intervertebral foramen.

Conclusion

DS is usually characterized of excessive hyperplasia of the SAP and Ac, both of which are possible elements of nerve root injury after complete reduction in operation and should be focused on during surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

Device Status/Drug Statement

The Manuscript submitted does not contain information about medical device(s)/drug(s).

References

  1. Akkawi I, Zmerly H (2022) Degenerative spondylolisthesis: a narrative review. Acta Bio-Med Atenei Parmensis 92(6):e2021313. https://doi.org/10.23750/abm.v92i6.10526

  2. Bydon M, Alvi MA, Goyal A (2019) Degenerative lumbar spondylolisthesis: definition, natural history, conservative management, and surgical treatment. Neurosurg Clin N Am 30(3):299–304. https://doi.org/10.1016/j.nec.2019.02.003

    Article  PubMed  Google Scholar 

  3. Grobler LJ, Robertson PA, Novotny JE, Pope MH (1993) Etiology of spondylolisthesis. Assessment of the role played by lumbar facet joint morphology. Spine 18(1): 80–91.

  4. Nagaosa Y, Kikuchi S, Hasue M, Sato S (1998) Pathoanatomic mechanisms of degenerative spondylolisthesis. A radiographic study. Spine 23(13):1447–1451. https://doi.org/10.1097/00007632-199807010-00004

    Article  CAS  PubMed  Google Scholar 

  5. Rai RR, Shah Y, Shah S, Palliyil NS, Dalvie S (2019) A radiological study of the association of facet joint tropism and facet angulation with degenerative spondylolisthesis. Neurospine, 16(4), 742–747. https://doi.org/10.14245/ns.1836232.116

  6. Hasegawa K, Kitahara K, Shimoda H, Ishii K, Ono M, Homma T, Watanabe K (2014) Lumbar degenerative spondylolisthesis is not always unstable: clinicobiomechanical evidence. Spine 39(26):2127–2135. https://doi.org/10.1097/BRS.0000000000000621

    Article  PubMed  Google Scholar 

  7. Toyone T, Ozawa T, Kamikawa K, Watanabe A, Matsuki K, Yamashita T, Wada Y (2009) Facet joint orientation difference between cephalad and caudad portions: a possible cause of degenerative spondylolisthesis. Spine 34(21):2259–2262. https://doi.org/10.1097/BRS.0b013e3181b20158

    Article  PubMed  Google Scholar 

  8. Aggarwal A, Garg K (2021) Lumbar facet fluid-does it correlate with dynamic instability in degenerative spondylolisthesis? A systematic review and meta-analysis. World Neurosurg 149:53–63. https://doi.org/10.1016/j.wneu.2021.02.029

    Article  PubMed  Google Scholar 

  9. Ben-Galim P, Reitman CA (2007) The distended facet sign: an indicator of position-dependent spinal stenosis and degenerative spondylolisthesis. Spine J Official J North Am Spine Soc 7(2):245–248. https://doi.org/10.1016/j.spinee.2006.06.379

    Article  Google Scholar 

  10. Shinto K, Minamide A, Hashizume H, Oka H, Matsudaira K, Iwahashi H, Ishimoto Y, Teraguchi M, Kagotani R, Asai Y, Muraki S, Akune T, Tanaka S, Kawaguchi H, Nakamura K, Yoshida M, Yoshimura N, Yamada H (2019) Prevalence of facet effusion and its relationship with lumbar spondylolisthesis and low back pain: the Wakayama spine study. J Pain Res 12:3521–3528. https://doi.org/10.2147/JPR.S227153

    Article  PubMed  PubMed Central  Google Scholar 

  11. Liu Z, Su Z, Wang M, Chen T, Cui Z, Chen X, Li S, Feng Q, Pang S, Lu H (2022) Computerized characterization of spinal structures on MRI and clinical significance of 3D reconstruction of lumbosacral intervertebral foramen. Pain Physician 25(1):E27–E35

    PubMed  Google Scholar 

  12. Yan S, Wang K, Zhang Y, Guo S, Zhang Y, Tan J (2018) Changes in L4/5 intervertebral foramen bony morphology with age. Sci Rep 8(1):7722. https://doi.org/10.1038/s41598-018-26077-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Paholpak P, Nazareth A, Khan YA, Khan SU, Ansari F, Tamai K, Buser Z, Wang JC (2019) Evaluation of foraminal cross-sectional area in lumbar spondylolisthesis using kinematic MRI. Euro J Orthop Surg Traumatol Orthopedie Traumatologie 29(1):17–23. https://doi.org/10.1007/s00590-018-2276-x

    Article  Google Scholar 

  14. Pearson A, Blood E, Lurie J, Tosteson T, Abdu WA, Hillibrand A, Bridwell K, Weinstein J (2010) Degenerative spondylolisthesis versus spinal stenosis: does a slip matter? Comparison of baseline characteristics and outcomes (SPORT). Spine 35(3):298–305. https://doi.org/10.1097/BRS.0b013e3181bdafd1

    Article  PubMed  PubMed Central  Google Scholar 

  15. Fay LY, Wu JC, Tsai TY, Wu CL, Huang WC, Cheng H (2013) Dynamic stabilization for degenerative spondylolisthesis: evaluation of radiographic and clinical outcomes. Clin Neurol Neurosurg 115(5):535–541. https://doi.org/10.1016/j.clineuro.2012.05.036

    Article  PubMed  Google Scholar 

  16. Reitman CA, Cho CH, Bono CM, Ghogawala Z, Glaser J, Kauffman C, Mazanec D, O’Brien D Jr, O’Toole J, Prather H, Resnick D, Schofferman J, Smith MJ, Sullivan W, Tauzell R, Truumees E, Wang J, Watters W 3rd, Wetzel FT, Whitcomb G (2021) Management of degenerative spondylolisthesis: development of appropriate use criteria. Spine J Offic J North Am Spine Soc 21(8):1256–1267. https://doi.org/10.1016/j.spinee.2021.03.005

    Article  Google Scholar 

  17. Schneider N, Fisher C, Glennie A, Urquhart J, Street J, Dvorak M, Paquette S, Charest-Morin R, Ailon T, Manson N, Thomas K, Rasoulinejad P, Rampersaud R, Bailey C (2021) Lumbar degenerative spondylolisthesis: factors associated with the decision to fuse. Spine J Offic J North Am Spine Soc 21(5):821–828. https://doi.org/10.1016/j.spinee.2020.11.010

    Article  Google Scholar 

  18. Epstein NE (2016) More nerve root injuries occur with minimally invasive lumbar surgery: Let’s tell someone. Surg Neurol Int 7(Suppl 3):S96–S101. https://doi.org/10.4103/2152-7806.174896

    Article  PubMed  PubMed Central  Google Scholar 

  19. Łuczkiewicz P, Smoczyński A, Smoczyński M (2002) Wpływ budowy stawów miedzykregowych w odcinku ledźwiowym na powstawanie kregozmyku zwyrodnieniowego [The influence of the morphology of intervertebral facet joints on the development of the degenerative spondylolisthesis]. Chir Narzadow Ruchu Ortop Pol 67(2):151–155

    PubMed  Google Scholar 

  20. Kim NH, Lee JW (1995) The relationship between isthmic and degenerative spondylolisthesis and the configuration of the lamina and facet joints. Euro Spine J Offic Publ Euro Spine Soc Euro Spinal Deformity Soc Euro Sect Cervical Spine Res Soc 4(3):139–144. https://doi.org/10.1007/BF00298237

    Article  CAS  Google Scholar 

  21. Miyazaki M, Morishita Y, Takita C, Yoshiiwa T, Wang JC, Tsumura H (2010) Analysis of the relationship between facet joint angle orientation and lumbar spine canal diameter with respect to the kinematics of the lumbar spinal unit. J Spinal Disord Tech 23(4):242–248. https://doi.org/10.1097/BSD.0b013e3181a8123e

    Article  PubMed  Google Scholar 

  22. Sugiura T, Okuda S, Matsumoto T, Maeno T, Yamashita T, Haku T, Iwasaki M (2018) Surgical outcomes and limitations of decompression surgery for degenerative spondylolisthesis. Global Spine J 8(7):733–738. https://doi.org/10.1177/2192568218770793

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The present study was supported by the National Natural Science Foundation of China (Grant No. 82002325), the Natural Science Foundation of Shandong Province (Grant Nos. ZR2020QH075, ZR2021MH167, ZR2021LZY004 and ZR2022LZY001), Municipal Innovation Plan of Clinical Medical Science and Technology of Jinan (202134043), Shandong medical and health science and technology development plan project (Grant No. 202004071188), Practical teaching reform and research project of Binzhou Medical College (Grant No. SJJY201927), Scientific research project of Affiliated Hospital of Binzhou Medical College (Grant No. BY2020KJ74), and Shandong Province traditional Chinese medicine science and technology project (Grant No. M-2022133).

Author information

Author notes

  1. Cheng Su and Xiaoyang Liu contributed equally to this study.

Authors and Affiliations

  1. Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, No. 9677, Jingshi Road, Jinan, Shandong Province, China

    Cheng Su, Xiaoyang Liu, Yuandong Shao, Guihe Yang, Jianmin Sun & Xingang Cui

  2. Department of Spine Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250000, Shandong, China

    Xiaoyang Liu, Wenchao Wang & Jianmin Sun

  3. Department of Spine Surgery, Binzhou People’s Hospital, Binzhou, 256600, Shandong, China

    Yuandong Shao

Authors
  1. Cheng Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaoyang Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuandong Shao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wenchao Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guihe Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jianmin Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xingang Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xingang Cui.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Su, C., Liu, X., Shao, Y. et al. Specific foraminal changes originate from degenerative spondylolisthesis on computed tomographic images. Eur Spine J 32, 1077–1086 (2023). https://doi.org/10.1007/s00586-023-07557-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-07557-z

Keywords

Search

Navigation