European Spine Journal

, Volume 19, Issue 11, pp 1865–1873 | Cite as

Degenerative lumbar spinal stenosis and lumbar spine configuration

  • J. AbbasEmail author
  • K. Hamoud
  • H. May
  • O. Hay
  • B. Medlej
  • Y. Masharawi
  • N. Peled
  • I. Hershkovitz
Original Article


As life expectancy increases, degenerative lumbar spinal stenosis (DLSS) becomes a common health problem among the elderly. DLSS is usually caused by degenerative changes in bony and/or soft tissue elements. The poor correlation between radiological manifestations and the clinical picture emphasizes the fact that more studies are required to determine the natural course of this syndrome. Our aim was to reveal the association between lower lumbar spine configuration and DLSS. Two groups were studied: the first included 67 individuals with DLSS (mean age 66 ± 10) and the second 100 individuals (mean age 63.4 ± 13) without DLSS-related symptoms. Both groups underwent CT images (Philips Brilliance 64) and the following measurements were performed: a cross-section area of the dural sac, vertebral body dimensions (height, length and width), AP diameter of the bony spinal canal, lumbar lordosis and sacral slope angles. All measurements were taken at L3 to S1. Vertebral body lengths were significantly greater in the DLSS group at all levels compared to the control, whereas anterior vertebral body heights (L3, L4, L5) and middle vertebral heights (L3, L5) were significantly smaller in the LSS group. Lumbar lordosis, sacral slope and bony spinal canal were significantly smaller in the DLSS compared to the control. We conclude that the size and shape of vertebral bodies and canals significantly differed between the study groups. A tentative model is suggested to explain the association between these characteristics and the development of degenerative spinal stenosis.


CT images Degenerative lumbar spinal stenosis Vertebral body dimensions Lumbar lordosis Sacral slope 



The authors wish to thank the Dan David Foundation, the Tassia, and Dr. Joseph Meychan, Chair for the History and Philosophy of Medicine, and the Israel science Foundation (ISF-1397/08) for their financial support. We also thank Margie Serling Cohn for her editorial and secretarial assistance.


  1. 1.
    Paine KW (1976) Clinical features of lumbar spinal stenosis. Clin Orthop 115:77–82PubMedGoogle Scholar
  2. 2.
    Wilson CB (1969) Significance of the small lumbar spinal canal: cauda equina compression syndromes due to spondylosis. J Neurosurg 31:499–506CrossRefPubMedGoogle Scholar
  3. 3.
    Amundsen T, Weber H, Lilleas F et al (1995) Lumbar spinal stenosis. Clinical and radiologic features. Spine 20:1178–1186CrossRefPubMedGoogle Scholar
  4. 4.
    Akuthota V, Lento P et al (2003) Pathogenesis of lumbar spinal stenosis pain: why does an asymptomatic stenotic patient flare? Phys med Rehabil Clin N Am 14:17–28PubMedGoogle Scholar
  5. 5.
    Coil MA, Deyo RA et al (1996) An assessment of surgery for spinal stenosis: time trends, geographic variations, complications and reoperations. J Am Geriatr Soc 44:285–290Google Scholar
  6. 6.
    Szpalski M, Gunzburg R (1998) The role of surgery in the management of low back pain. Baillieres Clin Rheumatol 12:141–159CrossRefPubMedGoogle Scholar
  7. 7.
    Arnoldi CC, Brodsky AE, Cauchoix J et al (1976) Lumbar spinal stenosis and nerve root entrapment syndromes: definition and classification. Clin Orthop 116:4–5Google Scholar
  8. 8.
    Lutter LD, Longstein JE, Winter RB, Langer LO (1977) Anatomy of the achondroplastic lumbar canal. Clin Orthop Relat Res 126:139–142PubMedGoogle Scholar
  9. 9.
    Singh K, Samartzis D, Vaccaro A, Nssr A et al (2005) Congenital lumbar spinal stenosis: a prospective, control-matched, cohort radiographic analysis. Spine J 5:615–622CrossRefPubMedGoogle Scholar
  10. 10.
    Kirkaldy-Willis WH, Wedge JH et al (1978) Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine 3:319–328CrossRefPubMedGoogle Scholar
  11. 11.
    Kirkaldy-Willis WH, Paine KE, Cauchoix J et al (1974) Lumbar spinal stenosis. Clin Orthop 99:30–50CrossRefPubMedGoogle Scholar
  12. 12.
    Kirkaldy-Willis WH, McIvor GW (1976) Spinal stenosis. Clin Orthop 115:2–144PubMedGoogle Scholar
  13. 13.
    Yong-Hing K, Kirkaldy-Willis WH (1983) The pathophysiology of degenerative disease of the lumbar spine. Orthop Clin North Am 14:491–515PubMedGoogle Scholar
  14. 14.
    Chynn KY, Altman I et al (1978) The roentgenographic manifestations and clinical features of lumbar spinal stenosis with special emphasis on the superior articular process. Neuroradiology 16:378–380CrossRefPubMedGoogle Scholar
  15. 15.
    Eisenstein S (1976) Measurements of the lumbar spinal canal in 2 racial groups. Clin Orthop 115:42–46PubMedGoogle Scholar
  16. 16.
    Eisenstein S (1977) The morphometry and pathological anatomy of the lumbar spine in South African Negroes and Caucasoid with specific reference to spinal stenosis. J Bone Joint Surg [Br] 59:173–180Google Scholar
  17. 17.
    Eisenstein S (1980) The trefoil configuration of the lumbar vertebral canal: a study of South African skeletal material. J Bone Joint Surg [Br] 62B:73–77Google Scholar
  18. 18.
    Sheldon JJ, Russin LA, Gargano FP (1976) Lumbar spinal stenosis Radiographic diagnosis with special reference to transverse axial tomography. Clin Orthop 115:53–67PubMedGoogle Scholar
  19. 19.
    Ullrich CG, Binet EF et al (1980) Quantitative assessment of the lumbar spinal canal by computed tomography. Radiology 134:137–143PubMedGoogle Scholar
  20. 20.
    Urso S, Pacciani E, Donnetti L (1986) The radiological diagnosis of spinal stenosis in the lumbar spinal canal. Ital J Orthop Traumatol 12:93–108PubMedGoogle Scholar
  21. 21.
    Bartolozzi P, Salvi M, Misasi M (1992) The diagnosis of lumbar stenosis. Chir Organi Mov 77:15–18PubMedGoogle Scholar
  22. 22.
    Luarencin CT, Lipson SJ, Senatus P et al (1999) The stenosis ratio: a new tool for diagnosis of degenerative spinal stenosis. Int J Surg Investig 1:127–131Google Scholar
  23. 23.
    Schonstrom N, Lindahl S, Willen J, Hansson T (1988) Dynamic changes in the dimensions of the lumbar spinal canal: an experimental study in vitro. J Orthop Res 7:115–121CrossRefGoogle Scholar
  24. 24.
    Ogikubo O, Forsberg L, Hansson T (2007) The relationship between the cross section area of cauda equina and preoperative symptoms in central lumbar spinal stenosis. Spine 32:1423–1429CrossRefPubMedGoogle Scholar
  25. 25.
    Kirkaldy-Willis WH, Wedge JH, Yong-Hing K et al (1982) Lumbar spinal nerve entrapment. Clin Orthop 169:171–178PubMedGoogle Scholar
  26. 26.
    Farfan HF, Sullivan JB (1967) The relation of facet orientation to intervertebral disc failure. Can J Surg 10:179–185PubMedGoogle Scholar
  27. 27.
    Herno A, Airaksinen O, Saari T (1994) Computed tomography after laminectomy for lumbar spinal stenosis. Spine 19:1975–1978CrossRefPubMedGoogle Scholar
  28. 28.
    Herno A, Saari T, Suomalainen O et al (1999) The degree of decompressive relief and its relation to clinical outcome in patients undergoing surgery for lumbar spinal stenosis. Spine 24:1010–1014CrossRefPubMedGoogle Scholar
  29. 29.
    Wiesel SW, Tsourmas N, Feffer HL et al (1984) A study of computer-assisted tomography I. The incidence of positive CAT scans in an asymptomatic group of patients. Spine 9:549–551CrossRefPubMedGoogle Scholar
  30. 30.
    Boden SD, Davis DO, Dina TA et al (1990) Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects: a prospective investigation. J Bone Joint Surg 72A:402–408Google Scholar
  31. 31.
    Verbiest H (1954) A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg 36B:230–237Google Scholar
  32. 32.
    Katz JN, Dagas M, Stucki G et al (1995) Degenerative lumbar spinal stenosis: Diagnosis value of history and physical examination. Arthritis Rheum 38:1236–1241CrossRefPubMedGoogle Scholar
  33. 33.
    Turner JA, Ersek M, Herron L et al (1992) Surgery for lumbar spinal stenosis: attempted meta-analysis of the literature. Spine 17:1–8CrossRefPubMedGoogle Scholar
  34. 34.
    Bolander NF, Schonstrom NS, Spengler DM (1985) Role of computed tomography and myelography in the diagnosis of central spinal stenosis. J Bone Joint Surg 67A:240–246Google Scholar
  35. 35.
    Schonstrom NS, Bolender NF, Spengler DM (1985) The pathomorphology of spinal stenosis as seen on CT scans of the lumbar spine. Spine 10:806–811CrossRefPubMedGoogle Scholar
  36. 36.
    Verbiest H (1975) Pathomorphologic aspect of developmental lumbar stenosis. Orthop Clin North Am 6:177–196PubMedGoogle Scholar
  37. 37.
    Verbiest H (1977) Results of surgical treatment of idiopathic developmental stenosis of the lumbar vertebral canal: a review of twenty-seven years experience. J Bone Surg [Br] 59:181–188Google Scholar
  38. 38.
    Cobb JR (1948) Outline for the study of scoliosis. AAOS Instr Course Lect 5:261Google Scholar
  39. 39.
    Ferguson AB (1934) The clinical and roentgenographic interpretation of lumbosacral anomalies. Radiology 22:548–558Google Scholar
  40. 40.
    Madsen R, Jensen TS, Pope M et al (2008) The effect of body position and a load on spinal canal morphology. Spine 33:61–67CrossRefPubMedGoogle Scholar
  41. 41.
    Andreasen ML, Langhoff L, Jensen TS, Albret HB (2007) Reproduction of the lumbar lordosis: a comparison of standing radiographs versus supine magnetic resonance imaging obtained with straightened lower extremities. J Manipulative Physiol Ther 30:26–30CrossRefPubMedGoogle Scholar
  42. 42.
    Eisenstein S (1977) The morphometry and pathological anatomy of the lumbar spine in South African negroes and caucasoids with specific reference to spinal stenosis. J Bone Joint Surg (Br) 59:1973–1980Google Scholar
  43. 43.
    Fciszewski T, Broste SK, Fardon D (1997) Quality of data regarding diagnoses of spinal disorders in administrative databases: a multicenter study. J Bone Joint Surg (Am) 79:1481–1488Google Scholar
  44. 44.
    Delamarter RB, Bohlman HH, Dodge LD, Biro C (1990) Experimental lumbar spinal stenosis: analysis of the cortical evoked potentials, microvasculature, and histopathology. J Bone Joint Surg [Am] 72:110–120Google Scholar
  45. 45.
    Chahal AS, Mundkur YJ, Sancheti HK, Arora R, Rastogi P (1982) Lumbar canal stenosis. Paraplegia 20:288–292PubMedGoogle Scholar
  46. 46.
    Katz JN, Dalgas M, Stucki G, Lipson SJ (1994) Diagnosis of lumbar spinal stenosis. Rheum Dis Clin North Am 20:471–483PubMedGoogle Scholar
  47. 47.
    Amundsen T, Weber H, Nordal HJ, Abdelnoor M, Magnaes B (2000) Lumbar spinal stenosis: conservative or surgical management? A prospective 10-year study. Spine 25:1424–1435CrossRefPubMedGoogle Scholar
  48. 48.
    An HS, Butler JP (1999) Lumbar spinal stenosis: historical perspective, classification, and pathoanatomy. Semin Spine Surg 11:184–190Google Scholar
  49. 49.
    Jenis LG, An HS (2000) Spine update: lumbar foraminal stenosis. Spine 25:389–394CrossRefPubMedGoogle Scholar
  50. 50.
    Postacchini F, Cinotti G (1992) Classification and pathomorphology of lumbar stenosis. Chir Organi Mov 77:7–14PubMedGoogle Scholar
  51. 51.
    Verbiest H (1950) Primary stenosis of the lumbar spinal canal in adults, a new syndrome. Ned Tijdschr Geneeskd 94:2415–2433PubMedGoogle Scholar
  52. 52.
    Verbiest H (1951) Further reports on primary stenosis of the lumbar spinal canal in adults. Ned Tijdschr Geneeskd 95:1965–1970PubMedGoogle Scholar
  53. 53.
    Eisenstein S (1983) Lumbar vertebral canal morphometry for computerized tomography in spinal stenosis. Spine 8:187–191CrossRefPubMedGoogle Scholar
  54. 54.
    Gouzien P, Cazalbou C, Boyer B et al (1990) Measurement of the normal lumbar spinal canal by computed tomography. Surg Radiol Anat 12:143–148CrossRefPubMedGoogle Scholar
  55. 55.
    Karantas AH, Zibis AH, Papaliaga M et al (1988) Dimensions of the lumbar spinal canal: variation and correlation with somatometric parameters using CT. Eur Radiol 8:1581–1585CrossRefGoogle Scholar
  56. 56.
    Postacchini F, Ripani M, Carpano S (1983) Morphometry of the lumbar vertebrae An anatomic study in two caucasoid ethnic groups. Clin Orthop Relat Res 172:296–303PubMedGoogle Scholar
  57. 57.
    Postacchini F (1996) Management of lumbar spinal stenosis. J Bone Joint Surg Br 78:154–164PubMedGoogle Scholar
  58. 58.
    Larsen JL, Smith D (1980) Size of the subarachnoid space in stenosis of the lumbar canal. Acta Radiol Diagn 21:627–632Google Scholar
  59. 59.
    Lee HM, Kim NH, Kim HJ, Chung IH (1995) Morphomertric study of the lumbar spinal canal in the Korean population. Spine 20:1679–1684CrossRefPubMedGoogle Scholar
  60. 60.
    Panjabi M, Goel V, Oxland T et al (1992) Human lumbar vertebrae, quantitative three-dimensional anatomy. Spine 17:299–306CrossRefPubMedGoogle Scholar
  61. 61.
    Rauschning W, Bergstrom k, Pech P (1983) Correlative craniospinal anatomy studies by computed tomography and cryomicrotomy. J Comput Assist Tomogr 7:9–13CrossRefPubMedGoogle Scholar
  62. 62.
    Postacchini F (1999) Surgical management of lumbar spinal stenosis. Spine 24:1043–1047CrossRefPubMedGoogle Scholar
  63. 63.
    Yukawa Y, Lenke LG, Tenhula J et al (2002) A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication. J Bone Joint Surg Am 84A:1954–1959Google Scholar
  64. 64.
    Athiviraham A, Yen D, Scott C, Soboleski D (2007) Clinical correlation of radiological spinal stenosis after standardization for vertebral body size. Clin Radiol 62:776–780CrossRefPubMedGoogle Scholar
  65. 65.
    Adams MA, Hutton WC (1980) The effect of posture on the role of the apophyseal joints in resisting intervertebral compressive forces. J Bone Joint Surg 62B:358–362Google Scholar
  66. 66.
    Adams MA, Hutton WC (1983) The mechanical function of the lumbar apophyseal joints. Spine 8:327–329CrossRefPubMedGoogle Scholar
  67. 67.
    Zheng F, Farmer JC, Sandhu HS, O’leary PF (2006) A novel method for quantitative evaluation of lumbar spinal stenosis. HSS J 2:136–140CrossRefPubMedGoogle Scholar
  68. 68.
    Shapiro R (1984) Myelography, 4th edn. Year Book, Chicago, pp 434–437Google Scholar
  69. 69.
    Waris E, Eskelin M, Hermunen H et al (2007) Disc degeneration in low back pain: a 17-year follow-up study using magnetic resonance imaging. Spine 32:681–684CrossRefPubMedGoogle Scholar
  70. 70.
    Epstein NF, Epstein JA (1991) Limbus lumbar vertebral fractures in 27 adolescents and adults. Spine 16:962–966CrossRefPubMedGoogle Scholar
  71. 71.
    Lippit AB (1976) Fracture of vertebral body end plate and disc protrusion causing subarachnoid block in an adolescent. Clin Orthop 116:112–115Google Scholar
  72. 72.
    Mangione P, Gomez D, Senegas J (1997) Study of the course of the incidence angle during growth. Eur Spine J 6:163–167CrossRefPubMedGoogle Scholar
  73. 73.
    Voutsinas SA, MacEwen GD (1986) Sagittal profiles of the spine. Clin Orthop 210:235–242PubMedGoogle Scholar
  74. 74.
    Bogduk N, Macintosh JE, Pearcy MJ (1992) A universal model of the lumbar back muscles in the upright position. Spine 17:897–913CrossRefPubMedGoogle Scholar
  75. 75.
    Gelb DE, Lenke LG, Bridwell KH et al (1992) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine 20:1351–1358Google Scholar
  76. 76.
    Kim HJ, Chung S, Shin H, Lee J et al (2006) Influence of trunk muscles on lumbar lordosis and sacral angle. Eur Spine J 15:409–414CrossRefPubMedGoogle Scholar
  77. 77.
    Mehlman CT, Araghi A, Roy DR (1997) Hyphenated history: the Hueter–Volkmann law. Am J Orthop 26:798–800PubMedGoogle Scholar
  78. 78.
    Park JB, Chang H, Lee JK (2001) Quantitative analysis of transforming growth factor-Beta 1 in ligamentum flavum of lumbar spinal stenosis and disc herniation. Spine 26:E492–E495CrossRefPubMedGoogle Scholar
  79. 79.
    Abbas J, Hamoud K, Masharawi Y et al (2010) Ligamentum flavum thickness in normal and stenotic lumbar spines. Spine Mar 5 (in press)Google Scholar
  80. 80.
    Sairyo K, Biyani A, Goel V et al (2005) Pathomechanism of ligamentum flavum hypertrophy: A Multidisciplinary investigation based on clinical, biomechanical, histologic, and biologic assessments. Spine 30:2649–2656CrossRefPubMedGoogle Scholar
  81. 81.
    Postacchini F, Gumina S, Cinotti G, Perugia D, DeMartino C (1994) Ligamenta flava in lumbar disc herniation and spinal stenosis Light and electron microscopic morphology. Spine 19:917–922CrossRefPubMedGoogle Scholar
  82. 82.
    Yoshida M, Shima K, Taniguchi Y et al (1992) Hypertrophied ligamentum flavum in lumbar spinal canal stenosis. Spine 17:1353–1360CrossRefPubMedGoogle Scholar
  83. 83.
    Schrader PK, Grob D, Rahn BA, Cordey J, Dvorak J (1999) Histology of the ligamentum flavum in patients with degenerative spinal stenosis. Eur Spine J 4:323–328CrossRefGoogle Scholar
  84. 84.
    Kerr TP, Lin JP, Gresty MA, Morley T, Robb SA (2008) Spinal stability is improved by inducing a lumbar lordosis in boys with Duchenne muscular dystrophy: a pilot study. Gait Posture 28:108–112CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • J. Abbas
    • 1
    Email author
  • K. Hamoud
    • 2
  • H. May
    • 1
  • O. Hay
    • 1
  • B. Medlej
    • 1
  • Y. Masharawi
    • 1
    • 3
  • N. Peled
    • 4
  • I. Hershkovitz
    • 1
  1. 1.Department of Anatomy and AnthropologySackler Faculty of Medicine, Tel-Aviv UniversityTel AvivIsrael
  2. 2.Spine UnitPoriya Medical CenterTiberiasIsrael
  3. 3.Department of Physical Therapy, The Stanly Steyer School of Health ProfessionsSackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
  4. 4.Department of RadiologyCarmel Medical CenterHaifaIsrael

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