Evaluation of foraminal cross-sectional area in lumbar spondylolisthesis using kinematic MRI

  • Permsak Paholpak
  • Alexander Nazareth
  • Yusuf A. Khan
  • Sameer U. Khan
  • Faisal Ansari
  • Koji Tamai
  • Zorica BuserEmail author
  • Jeffrey C. Wang



To evaluate the kinematic change of cross-sectional area of lumbar intervertebral foramen in degenerative lumbar spondylolisthesis patients using multi-positional MRI.


Multi-positional MRI was performed on 31 patients diagnosed with single or multilevel degenerative lumbar spondylolisthesis and 31 control patients without degenerative lumbar spondylolisthesis. Foraminal area (FA) was measured at the lumbar spondylolisthesis level in degenerative lumbar spondylolisthesis group and at L3-4, L4-5, and L5-S1 level in the control group. FA was measured bilaterally in neutral, flexion, and extension positions. The difference in FA between the groups was analyzed using Mann–Whitney U test, and the difference between positions within groups was analyzed using Wilcoxon signed-rank test.


Degenerative lumbar spondylolisthesis group showed significantly smaller FA on both sides and on average in all three positions compared to the control group (p < 0.05 all). From neutral to flexion position, the change in FA was significantly smaller in the degenerative lumbar spondylolisthesis group than in the control group on both sides and on average (p < 0.005 all). In degenerative lumbar spondylolisthesis group, the FA showed no significant change from neutral to flexion, but showed significant change from neutral to extension (p < 0.005 all).


FA in the degenerative lumbar spondylolisthesis group was smaller than in the control group. There was no difference in FA in degenerative lumbar spondylolisthesis group from neutral to flexion, only from neutral to extension. Patients with degenerative lumbar spondylolisthesis have a higher chance of developing foraminal stenosis.


Degenerative spondylolisthesis Lumbar spondylolisthesis Foramina area Foraminal stenosis Degenerative lumbar Multi-positional MRI 



The study was supported by departmental funds. Authors would like to thank AiM Radiology Medical Group, especially to Aziza Qadir MD for the help in overseeing the upload of multi-positional MRI images into the database.


Disclosures outside of submitted work: ZB—Xenco Medical (consultancy), AO Spine (consultancy); JCW—Royalties—Biomet, Seaspine, Amedica, DePuy Synthes; Investments/Options—Fziomed, Promethean, Paradigm Spine, Benvenue, Nexgen, Vertiflex, Electrocore, Surgitech, Expanding Orthopedics, Osprey, Bone Biologics, Pearldiver; Board of Directors—North American Spine Society (non-financial, reimbursement for travel for board meetings, courses etc.), North American Spine Foundation (non-financial), AO Foundation (financial, $20,000 honorariums for board positions, plus travel for board meetings), Cervical Spine Research Society (non-financial, reimbursement for travel for board meetings); Editorial Boards—Spine, JAAOS, The Spine Journal, Clinical Spine Surgery, Global Spine Journal; Fellowship Funding (paid to institution): AO Foundation. Yusuf A. Khan, Sameer U. Khan—family relationships (a family member owner of kMRI imaging center).

Compliance with ethical standards

Conflict of interest

No conflict of interest for the current study.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Department of Orthopaedics, Faculty of MedicineKhon Kaen UniversityKhon KaenThailand
  3. 3.AiM Radiology Medical GroupBellflowerUSA
  4. 4.Department of OrthopedicsOsaka City University Graduate School of MedicineOsakaJapan

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