title: Quantitative analysis of changes in cervical intervertebral foramen size with vertebral translation.
abstract: METHODS
  Simulated translation of the C5 vertebra was performed in 20 embalmed cadaveric cervical spines, and cross-sectional areas of the C4-C5 and C5-C6 intervertebral foramina were measured and compared before and after translation of the C5 vertebra.
  
  
  OBJECTIVE
  To determine the relationship of cross-sectional intervertebral foraminal areas to the degrees of vertebral translation.
  
  
  BACKGROUND
  The common feature of clinical instability and adjacent diseases of the cervical spine is malalignment of the cervical spine (i.e., there is ventral and dorsal translation of vertebral body with respect to the adjacent upper and lower vertebral body, respectively). To our knowledge, no previous study has analyzed the quantitative effect of vertebral translation on the size of the intervertebral foramina.
  
  
  METHODS
  The cross-sectional areas of the intervertebral foramina at C4-C5 and C5-C6 were measured on computerized tomography. The images were then transferred to the personal computer, where consecutive dorsal translations of C5 vertebrae with a 1-mm increment from 1 to 5-mm displacements were performed using Microsoft paint software (Microsoft, Corp., Redmond, WA). National Institutes of Health (Bethesda, MD) Image J software (V1.33m) was then used to measure the areas of both sides of C4-C5 and C4-C6 foramina at normal and each displacement level in the computer.
  
  
  RESULTS
  Following dorsal translation of C5 vertebra, anterolisthesis of C4 relative to C5 and retrolisthesis of C5 relative to C6 was noted. No significant difference was found between the measured values using Aquarius Image software (Microsoft, Corp.) on computerized tomography and National Institutes of Health image J software on the desktop computer (P > 0.05). When compared with normal values, there was an increase in the C4-C5 intervertebral foraminal area (i.e., 6%, 14%, 18%, 21%, and 26% with anterolisthesis of C4 relative to C5 following 1, 2, 3, 4, and 5-mm dorsal translation of the C5 vertebra, respectively). There was a 12% decrease in the C5-C6 intervertebral foraminal area, with each 1-mm incremental retrolisthesis of C5 relative to C6 vertebra. Statistically significant differences were found among residual cross-sectional foraminal areas following different degrees of dorsal translation (P < 0.05).
  
  
  CONCLUSIONS
  There is a significant increase in size with anterolisthesis and decrease in size with retrolisthesis of upper and lower adjacent vertebral intervertebral foramina, respectively.
authors.affiliation: Department of Orthopaedic Surgery, Medical College of Ohio, Toledo, OH 43614, USA. nebraheim@mco.edu
authors.forename: Nabil A
authors.initials: NA
authors.lastname: Ebraheim
authors.forename: Jiayong
authors.initials: J
authors.lastname: Liu
authors.forename: Qaiser
authors.initials: Q
authors.lastname: Shafiq
authors.forename: Jike
authors.initials: J
authors.lastname: Lu
authors.forename: Sravanthy
authors.initials: S
authors.lastname: Pataparla
authors.forename: Richard A
authors.initials: RA
authors.lastname: Yeasting
authors.forename: Lee
authors.initials: L
authors.lastname: Woldenberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D003198:Computer Simulation; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D014057:Tomography, X-Ray Computed / Q000379:methods