title: Influence of anatomical variations on lumbar foraminal stenosis pathogenesis.
abstract: BACKGROUND
  Symptomatic foraminal stenosis has been observed in patients with degenerative disc disease, scoliosis, asymmetrical disc degeneration and spondylolisthesis. Nevertheless not all patients with the above pathologies will develop symptomatic foraminal stenosis. We hypothesised that symptomatic patients have anatomical predisposition to foraminal stenosis, namely a larger pedicle height (PH) to vertebral body height (VH) ratio, leaving less room below the pedicle for the exiting nerve root compared to asymptomatic patients.
  
  
  METHODS
  66 Patients were divided in two groups. The surgical group consisted of 37 patients (average age of 61 years) who presented with severe radicular symptoms resisting to conservative measures and requiring decompression and transforaminal lumbar interbody fusion (TLIF). The control group consisted of 29 patients (average age of 51 years) presenting with low back pain (LBP) but with no radicular symptoms and who were treated conservatively.
  
  
  METHODS
  We measured VH at the level of the posterior wall as well as PH on parasagittal images (CT or MRI) on all lumbar levels (L1 to L5). Statistical analysis was performed using Student's t test.
  
  
  RESULTS
  No difference in PH was found between the two groups for L1 to L4 levels. By contrast, there was a highly statistically significant difference in VH between the two groups from L1 to L4 level. In the surgical group, the VH was smaller (p < 0.001).
  
  
  CONCLUSIONS
  Symptomatic patients with foraminal stenosis have smaller VH leading to lesser space beneath the pedicle and putting the exiting nerve root at risk in cases of spondylolisthesis or disc degeneration.
authors.affiliation: Orthopedic Department, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, 1011, Lausanne, Switzerland, sophie@merckaert.ch.
authors.forename: Sophie
authors.initials: S
authors.lastname: Merckaert
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Pierzchala
authors.forename: Gerit
authors.initials: G
authors.lastname: Kulik
authors.forename: Constantin
authors.initials: C
authors.lastname: Schizas
mesh_terms: D000368:Aged; D003251:Constriction, Pathologic; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000473:pathology* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000601:surgery; D012600:Scoliosis / Q000601:surgery; D013123:Spinal Fusion